Plasma total homocysteine levels (tHcy) is lowered by high insulin levels, and it can be elevated in insulin-resistant states. However, it is uncertain whether plasma tHcy and insulin or any components of the metabolic syndrome has any relationship among hypertensive individuals. In this study the tHcy and insulin concentrations were measured by enzyme immunoassay techniques in samples from 41 (27 male and 14 female) participants. Components of the metabolic syndrome (insulin resistance) profiles were also evaluated. The participants’ age ranged from 31 to 67 years (mean+SEM, 52.1±1.3 years), body mass index from 20.2 to 38.3 kg/m2 (27.2±0.7 kg/m2), plasma tHcy concentration from 6.9 to 16.2 μmol/L (11.0±0.4 μmol/L), and plasma insulin 3.0 to 16.6 μIU/mL (7.3±0.5 μIU/mL). A significant negative correlation was found between tHcy concentrations and insulin levels (r=-0.358, P=0.011), but not with other variables (P>0.05). In conclusion, the tHcy concentration is significantly related to plasma insulin in hypertensive subjects. tHcy concentrations were independent of the components of the metabolic syndrome and other risk factors of coronary heart disease in hypertensive subjects.
Hypertension is a prevalent chronic disease, which is strongly related to the development of cerebrovascular and cardiovascular diseases. The prevalence of hypertension in Malaysia in subjects aged 15 years and above was estimated to be 27.8%. Cost-effectiveness analysis (CEA) compares treatment options with different effectiveness and safety profiles. The utilisation of antihypertensive drugs has raised some concerns about the balance between its costs and benefits. This study was conducted to describe the healthcare costs for hypertensive subjects and to examine the cost-effectiveness of different classes of antihypertensive drugs used in Malaysia. Retrospective and prospective data analysis of a cohort of uncomplicated hypertensive patients was conducted to determine ambulatory health care costs among hypertensive patients groups. The total direct and
indirect costs of controlled and uncontrolled blood pressure (BP) were described. The health care
costs ($) / clinical outcome (AC/E ratio) was calculated. Mean total direct costs per patient per month was higher in uncontrolled blood pressure groups compared to the controlled blood pressure groups. The cost-effectiveness relationship was more favourable for diuretics (1.9), angiotensin converting enzyme inhibitors (ACEIs) (2.0), prazosin (2.4) and beta blockers (2.5), more than the diuretics and beta blockers combination theraphy (3.0), calcium channel blockers (CCBs) (3.4) and other combinations (6.1). Antihypertensive drugs used to treat hypertensive patients were different
in their cost-effectiveness ratios. Such results will allow health care professionals and/or decision
makers to make better decisions on how to select treatment options for hypertensive patients in
Malaysia and how to distribute and allocate scarce health care resources. Pharmacoeconomic
evaluations can help in making difficult choices rationally and allocate scarce resources efficiently.