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  1. Narayan, K.A., A Rashid, K.
    MyJurnal
    This study was conducted to study the blood pressure pattern and the prevalence of hypertension and its associated factors in a rural community in two coastal villages in rural Kedah, Mahysia. Out of the total population 504 were above 20 years of age and were eligible to participate. There were 227 males and 252 females. The mean systolic blood pressure was found to rise with age, peaking in the 6l·70 years age group, For women the mean blood pressure rose earlier from the age group of 4-l· 50 years. Mean blood pressures rose with increasing body mass index. lt also varied with occupation and education. The retired and unemployed had a higher blood pressure than those employed and there was an inverse relationship with increasing education. The prevalence of hypertension was 33.6%. More females were hypertensive (36.5%) as compared to males (3 0.4%) and this finding was the same for both systolic and diastolic hypertension. Majority (71.4%) of the hypertensives were undiagnosed. 72.5% of hypertensives who were on treatment were not under control. Hypertension was more prevalent among retirees and illiterates. Prevalence of hypertension increased correspondingly with age. Obesity was associated with hypertension. There was no association with family history of hypertension. Multiple logistic regression showed a positive association only for obesity. ln conclusion, given the high prevalence of hypertension at
    present, it appears that the prevalence will increase as each age cohort grows older. Obesity, especially among housewives is a significant assorted factor.
    Matched MeSH terms: Hypertension
  2. Tromp J, Tay WT, Ouwerkerk W, Teng TK, Yap J, MacDonald MR, et al.
    PLoS Med, 2018 03;15(3):e1002541.
    PMID: 29584721 DOI: 10.1371/journal.pmed.1002541
    BACKGROUND: Comorbidities are common in patients with heart failure (HF) and complicate treatment and outcomes. We identified patterns of multimorbidity in Asian patients with HF and their association with patients' quality of life (QoL) and health outcomes.

    METHODS AND FINDINGS: We used data on 6,480 patients with chronic HF (1,204 with preserved ejection fraction) enrolled between 1 October 2012 and 6 October 2016 in the Asian Sudden Cardiac Death in Heart Failure (ASIAN-HF) registry. The ASIAN-HF registry is a prospective cohort study, with patients prospectively enrolled from in- and outpatient clinics from 11 Asian regions (Hong Kong, Taiwan, China, Japan, Korea, India, Malaysia, Thailand, Singapore, Indonesia, and Philippines). Latent class analysis was used to identify patterns of multimorbidity. The primary outcome was defined as a composite of all-cause mortality or HF hospitalization within 1 year. To assess differences in QoL, we used the Kansas City Cardiomyopathy Questionnaire. We identified 5 distinct multimorbidity groups: elderly/atrial fibrillation (AF) (N = 1,048; oldest, more AF), metabolic (N = 1,129; obesity, diabetes, hypertension), young (N = 1,759; youngest, low comorbidity rates, non-ischemic etiology), ischemic (N = 1,261; ischemic etiology), and lean diabetic (N = 1,283; diabetic, hypertensive, low prevalence of obesity, high prevalence of chronic kidney disease). Patients in the lean diabetic group had the worst QoL, more severe signs and symptoms of HF, and the highest rate of the primary combined outcome within 1 year (29% versus 11% in the young group) (p for all <0.001). Adjusting for confounders (demographics, New York Heart Association class, and medication) the lean diabetic (hazard ratio [HR] 1.79, 95% CI 1.46-2.22), elderly/AF (HR 1.57, 95% CI 1.26-1.96), ischemic (HR 1.51, 95% CI 1.22-1.88), and metabolic (HR 1.28, 95% CI 1.02-1.60) groups had higher rates of the primary combined outcome compared to the young group. Potential limitations include site selection and participation bias.

    CONCLUSIONS: Among Asian patients with HF, comorbidities naturally clustered in 5 distinct patterns, each differentially impacting patients' QoL and health outcomes. These data underscore the importance of studying multimorbidity in HF and the need for more comprehensive approaches in phenotyping patients with HF and multimorbidity.

    TRIAL REGISTRATION: ClinicalTrials.gov NCT01633398.
    Matched MeSH terms: Hypertension/complications; Hypertension/epidemiology
  3. Salleh NA, Ismail S, Ab Halim MR
    Pharmacognosy Res, 2016 Oct-Dec;8(4):309-315.
    PMID: 27695274 DOI: 10.4103/0974-8490.188873
    BACKGROUND: Curcuma xanthorrhiza is a native Indonesian plant and traditionally utilized for a range of illness including liver damage, hypertension, diabetes, and cancer.
    OBJECTIVE: The study determined the effects of C. xanthorrhiza extracts (ethanol and aqueous) and their constituents (curcumene and xanthorrhizol) on UDP-glucuronosyltransferase (UGT) and glutathione transferase (GST) activities.
    MATERIALS AND METHODS: The inhibition studies were evaluated both in rat liver microsomes and in human recombinant UGT1A1 and UGT2B7 enzymes. p-nitrophenol and beetle luciferin were used as the probe substrates for UGT assay while 1-chloro-2,4-dinitrobenzene as the probe for GST assay. The concentrations of extracts studied ranged from 0.1 to 1000 μg/mL while for constituents ranged from 0.01 to 500 μM.
    RESULTS: In rat liver microsomes, UGT activity was inhibited by the ethanol extract (IC50 =279.74 ± 16.33 μg/mL). Both UGT1A1 and UGT2B7 were inhibited by the ethanol and aqueous extracts with IC50 values ranging between 9.59-22.76 μg/mL and 110.71-526.65 μg/Ml, respectively. Rat liver GST and human GST Pi-1 were inhibited by ethanol and aqueous extracts, respectively (IC50 =255.00 ± 13.06 μg/mL and 580.80 ± 18.56 μg/mL). Xanthorrhizol was the better inhibitor of UGT1A1 (IC50 11.30 ± 0.27 μM) as compared to UGT2B7 while curcumene did not show any inhibition. For GST, both constituents did not show any inhibition.
    CONCLUSION: These findings suggest that C. xanthorrhiza have the potential to cause herb-drug interaction with drugs that are primarily metabolized by UGT and GST enzymes.
    SUMMARY: Findings from this study would suggest which of Curcuma xanthorrhiza extracts and constituents that would have potential interactions with drugs which are highly metabolized by UGT and GST enzymes. Further clinical studies can then be designed if needed to evaluate the in vivo pharmacokinetic relevance of these interactions Abbreviations Used: BSA: Bovine serum albumin, CAM: Complementary and alternative medicine, cDNA: Complementary deoxyribonucleic acid, CDNB: 1-Chloro-2,4-dinitrobenzene, CuSO4.5H2O: Copper(II) sulfate pentahydrate, CXEE: Curcuma xanthorrhiza ethanol extract, CXAE: Curcuma xanthorrhiza aqueous extract, GC-MS: Gas chromatography-mass spectroscopy, GSH: Glutathione, GST: Glutathione S-transferase, KCl: Potassium chloride, min: Minutes, MgCl2: Magnesium chloride, mg/mL: Concentration (weight of test substance in milligrams per volume of test concentration), mM: Milimolar, Na2CO3: Sodium carbonate, NaOH: Sodium hydroxide, nmol: nanomol, NSAIDs: Non-steroidal antiinflammatory drug, p-NP: para-nitrophenol, RLU: Relative light unit, SEM: Standard error of mean, UDPGA: UDP-glucuronic acid, UGT: UDP-glucuronosyltransferase.
    KEYWORDS: Curcuma xanthorrhiza; UDP-glucuronosyltransferase; glutathione transferase; xanthorrhizol
    Matched MeSH terms: Hypertension
  4. Draman, S., Maliya, S., Farhan, A., Syazwan, S., Nur ‘Atikah A., Abd Aziz, K.H.
    MyJurnal
    Introduction: Mak nyahs (male-to-female transgenders) often consume feminizing hormones to achieve and maintain the female physical appearance. They do it without professional prescription/advise, and often take excessive doses. This renders them at risk of developing complications of hormone consumption. This paper provides some quantitative data on hormone consumption among mak nyahs in Kuantan, Pahang, in Malaysia. Materials and Methods: A cross-sectional study was carried out from July to August in 2015 among 35 mak nyahs. Convenience sampling was used. Participants who gave consent answered an interview-guided questionnaire which documents socio-demographic profile, hormone usage, and morbidities as a result of hormone consumption. Data was analysed using SPSS, Version 16.0. (version 16). Results: Majority of the subjects were Malays (91.4%) and Muslims (97.1%), their median (IQR) age being 31 (±17) years, more than half (57.1%) were between 20 to 40 years old. Most (80.0%) of them are sex workers. Oral hormone was most commonly used (88.6%), while more than half (67.7%) of them added hormone injections. Almost all subjects purchased hormones over the counter from local pharmacies (94.2%). However, many received information on hormone from non-professional sources. Possible adverse effects of hormones reported among subjects were hypertension, ischemic heart disease, diabetes mellitus, and venous thrombo-embolism. Conclusion: Hormone consumption was very common among the subjects in this study, and may be associated with certain medical problems. Medical personnel must pay more attention in educating the mak nyahs on adverse effects of hormones consumption. Mak nyahs should also be screened for complications every time they seek medical attention.
    Matched MeSH terms: Hypertension
  5. Dharmalingam TK, Nor Azian AZ, Thiruselvi S, Abdul Aziz J
    Med J Malaysia, 2013 Apr;68(2):177-8.
    PMID: 23629572
    Left bundle branch block (LBBB) during anaesthesia is uncommon. During general anaesthesia, LBBB may be related to hypertension or tachycardia and its acute onset makes the diagnosis of acute myocardial ischemia or infarction difficult. We would like to present a case report of a healthy patient who developed LBBB intra operatively. Acute LBBB should lead to suspicion of acute coronary syndrome until proven otherwise. Inability to exclude an acute cardiac event resulted in postponement of surgery twice after general anaesthesia was administered. Cardiological investigation of our patient showed physiological left ventricular hypertrophy (LVH), "athlete's heart" which was the most likely cause of the LBBB under anaesthesia.
    Matched MeSH terms: Hypertension
  6. Masiran R, Abdul Aziz MF
    BMJ Case Rep, 2017 Aug 28;2017.
    PMID: 28847993 DOI: 10.1136/bcr-2017-220631
    A patient with bipolar I disorder has been treated with lithium and haloperidol for the last 20 years and received an ACE inhibitor for his hypertension since 9 years ago. Despite regular clinic follow-ups and blood monitoring, he recently developed tremors and delirium. On hospital admission, serum level of lithium was far above toxic level. Mental state examination revealed an anxious and disorientated man with irrelevant speech. Immediate discontinuation of lithium resulted in slow reduction of serum lithium levels and gradual resolution of tremor but his delirium persisted for 2 weeks. His condition took a turn for the worse when he developed acute renal failure and arm abscess. We discussed about lithium toxicity and the vulnerability factors which have induced delirium and renal failure in this patient.
    Matched MeSH terms: Hypertension/drug therapy*
  7. Sharifuddin N, Abdul Aziz AF, Sheikh Hamzah M, Abdul Rashid R, Zainuddin Z, Wan Puteh SE, et al.
    Background: Erectile dysfunction (ED) is common amongst hypertensive men. Hypertensive patients often attribute it to antihypertensive drugs, although conflicting evidence linking ED with antihypertensive medication exists. The objectives were to determine the prevalence and severity of ED, the type of treatment sought, and the risk factors for ED among hypertensive men.
    Method: A cross-sectional survey conducted over six months from June to November 2008 at University Kebangsaan, Malaysia Medical Centre, Kuala Lumpur. Inclusion criteria included hypertensive men above 30 years old, with essential hypertension for at least three months. We excluded diabetics, a history of pelvic surgery and known psychiatric illnesses. The International Index of Erectile Function-5 (IIEF-5) assessment was used with a standardised checklist. We analysed data using SPSS, to assess the prevalence and association of ED with selected variables.
    Results: Of the 200 participants screened, 35.5% perceived that they had ED. However, prevalence increased to 69% after screening using an IIEF-5 questionnaire. Forty-eight per cent were reported to have moderate-to severe ED. ED was significantly associated with age (p-value = 0.0001). No significant associations were found between ED and the duration of the hypertension (p-value = 0.505), hypertension control (p-value > 0.05), smoking status (p-value = 0.858) or number of antihypertensive medication taken (p-value > 0.05). Among perceived and proven ED patients, traditional medicines were mainly used for treatment (18.3% and 17.2% respectively).
    Conclusion: ED is a problem among hypertensive patients. It was associated with age but not with hypertension duration, control, number of antihypertensive drugs or smoking. Physicians should enquire about ED symptoms in hypertensive patients, as most of them resorted to self-treatment with traditional medicines. © SAAFP.
    Matched MeSH terms: Hypertension
  8. Kumolosasi E, Ng WB, Abdul Aziz SA
    Med J Malaysia, 2012 Aug;67(4):379-85.
    PMID: 23082445 MyJurnal
    Hypertension has been identified as one of the causes for end stage renal failure (ESRF) and is likely to worsen kidney function. This retrospective study was carried out at a tertiary hospital in Malaysia with the objective of determining the effectiveness of combination antihypertensive drugs in hypertensive patients with ESRF admitted between 2006 and 2008. Patients with incomplete data and who were on monotherapy were excluded from this study. Although six different combinations gave significant reductions in systolic blood pressure (SBP) (13.38 +/- 9.11 mmHg, p < 0.05) and diastolic blood pressure (DBP) (6.03 +/- 11.39 mmHg, p < 0.05), 69.16% patients did not achieve target blood pressure (BP) (< or = 130/80 mmHg). Combination of beta blocker (BB) with calcium channel blocker (CCB) was the most commonly used. The CCB-diuretic regimen achieved highest percentage of BP control compared to others (40%). Comparison of blood pressure reduction between different combinations of antihypertensive drugs were not significant (p > 0.05) except for CCB-diuretics and BB-CCB-alpha blocker. The findings suggested better BP control with CCB-diuretic relative to other combinations used.
    Matched MeSH terms: Hypertension/complications*; Hypertension/drug therapy*
  9. Cheng HS, Ton SH, Tan JBL, Abdul Kadir K
    Nutrients, 2017 Sep 07;9(9).
    PMID: 28880217 DOI: 10.3390/nu9090984
    The clinical value of tocotrienols is increasingly appreciated because of the unique therapeutic effects that are not shared by tocopherols. However, their effect on metabolic syndrome is not well-established. This study aimed to investigate the effects of a tocotrienol-rich fraction (TRF) from palm oil in high-fat-diet-treated rats. Male, post-weaning Sprague Dawley rats were provided high-fat (60% kcal) diet for eight weeks followed by a TRF (60 mg/kg) treatment for another four weeks. Physical, metabolic, and histological changes were compared to those on control and high-fat diets respectively. High-fat feeding for eight weeks induced all hallmarks of metabolic syndrome. The TRF reversed systolic and diastolic hypertension, hypercholesterolemia, hepatic steatosis, impaired antioxidant defense, and myeloperoxidase hyperactivity triggered by the high-fat diet. It also conferred an inhibitory effect on protein glycation to reduce glycated hemoglobin A1c and advanced glycation end products (AGE). This was accompanied by the suppression of the receptor for advanced glycation end product (RAGE) expression in the liver. The treatment effects on visceral adiposity, glycemic control, triglyceride level, as well as peroxisome proliferator-activated receptor α and γ expression were negligible. To conclude, treatment with a TRF exhibited protective effects on the cardiovascular and liver health in addition to the amelioration of plasma redox imbalance and AGE-RAGE activation. Further investigation as a therapy for metabolic syndrome is therefore worthwhile.
    Matched MeSH terms: Hypertension/chemically induced*
  10. Cheng HS, Ton SH, Phang SCW, Tan JBL, Abdul Kadir K
    J Adv Res, 2017 Nov;8(6):743-752.
    PMID: 29062573 DOI: 10.1016/j.jare.2017.10.002
    The present study aimed to examine the effects of the types of high-calorie diets (high-fat and high-fat-high-sucrose diets) and two different developmental stages (post-weaning and young adult) on the induction of metabolic syndrome. Male, post-weaning and adult (3- and 8-week old, respectively) Sprague Dawley rats were given control, high-fat (60% kcal), and high-fat-high-sucrose (60% kcal fat + 30% sucrose water) diets for eight weeks (n = 6 to 7 per group). Physical, biochemical, and transcriptional changes as well as liver histology were noted. Post-weaning rats had higher weight gain, abdominal fat mass, fasting glucose, high density lipoprotein cholesterol, faster hypertension onset, but lower circulating advanced glycation end products compared to adult rats. This is accompanied by upregulation of peroxisome proliferator-activated receptor (PPAR) α and γ in the liver and receptor for advanced glycation end products (RAGE) in the visceral adipose tissue. Post-weaning rats on high-fat diet manifested all phenotypes of metabolic syndrome and increased hepatic steatosis, which are linked to increased hepatic and adipocyte PPARγ expression. Adult rats on high-fat-high-sucrose diet merely became obese and hypertensive within the same treatment duration. Thus, it is more effective and less time-consuming to induce metabolic syndrome in male post-weaning rats with high-fat diet compared to young adult rats. As male rats were selectively included into the study, the results may not be generalisable to all post-weaning rats and further investigation on female rats is required.
    Matched MeSH terms: Hypertension
  11. Wong AP, Kassab YW, Mohamed AL, Abdul Qader AM
    Pak J Pharm Sci, 2018 Jan;31(1):237-244.
    PMID: 29348109
    Hypertension is one of the major causes of morbidity and mortality. Worldwide, Hypertension is estimated to cause 7.5 million deaths, about 12.8% of the total of all deaths. This accounts for 57 million disability adjusted life years (DALYS) or 3.7% of total DALYS. This led WHO to set a target of 25% reduction in prevalence by 2025. To reach that, WHO has adopted non-conventional methods for the management of hypertension? Despite worldwide popularity of such non-conventional therapies, only small volume of evidence exists that supports its effectiveness. This review attempted to make a critical appraisal of the evidence, with the aim to (1) describe the therapeutic modalities frequently used, and (2) review the current level of evidence attributable to each modality. Databases from Cochrane Library, MEDLINE, PUBMED, and EMBASE were searched from 2005-2015. A total of 23 publications have been identified and selected. Out of these, 15 systematic reviews and/or meta-analysis of RCTs, 5 RCTs, 1 non-RCT, and 2 observational studies without control. Among those 23 publications, therapeutic modalities identified are: fish oil, qigong, yoga, coenzyme Q10, melatonin, meditation, vitamin D, vitamin C, monounsaturated fatty acids, dietary amino-acids, chiropractic, osteopathy, folate, inorganic nitrate, beetroot juice, beetroot bread, magnesium, and L-arginine. The followings were found to have weak or no evidence: fish oil, yoga, vitamin D, monounsaturated fatty acid, dietary amino-acids, and osteopathy. Those found to have significant reduction in blood pressure are: magnesium, qigong, melatonin, meditation, vitamin C, chiropractic, folate, inorganic nitrate, beetroot juice and L-arginine. Coenzyme Q10on the other hand, showed contradicting results were some studies found weak or no effect on blood pressure while others showed significant blood pressure reduction effect. By virtue of the research designs and methodologies, the evidence contributed from these studies is at level 1. Results from this review suggest that certain non-conventional therapies may be effective in treating hypertension and improving cardiac function and therefore considered as part of an evidence-based approach.
    Matched MeSH terms: Hypertension/drug therapy; Hypertension/therapy*
  12. Rehman A, Ismail SB, Naing L, Roshan TM, Abdul Rahman AR
    Am J Hypertens, 2007 Feb;20(2):184-9.
    PMID: 17261465 DOI: 10.1016/j.amjhyper.2006.07.015
    BACKGROUND: Data comparing the effect of losartan and perindopril on aortic stiffness among hypertensive subjects without A(1166)C polymorphism was not available.
    METHODS: The short-term and long-term effects of losartan (50 mg) and perindopril (4 mg) on aortic stiffness measured as carotid femoral pulse wave velocity (PWV) were compared in 39 middle-aged Malay subjects with mild-to-moderate hypertension in a 4-month, double-blind, randomized, controlled, parallel-design study.
    RESULTS: Four-month treatment with both drugs showed a significant reduction in blood pressure (BP) (P < .005) and PWV (P < .05) as compared to the baseline. On the other hand 1-month treatment showed a significant reduction in BP only in perindopril group (P < .05) but not in the losartan group. There was no significant reduction in pulse pressure and PWV after 1 month treatment by both drugs. No significant difference was seen in reduction in BP after 1 month and 4 months treatment between the two drugs. Similarly no significant difference was seen in reduction in PWV between the two drugs after 1 month (P = .613) and 4 months (P = .521) of treatment. Reduction in PWV by losartan (r = 0.470) and perindopril (r = 0.457) correlated significantly only with reduction in DBP (P < .05) and remained significant even after controlling for reduction in DBP (P < .05). Reduction in PWV by both losartan and perindopril was independent of reduction in BP by these drugs.
    CONCLUSIONS: These results showed that long-term treatment with losartan shows similar pressure independent reduction in PWV as perindopril among Malay hypertensive subjects with a homogenous "AA" genotype for angiotensin II type 1 receptor and may serve as a suitable alternative to perindopril.
    Matched MeSH terms: Hypertension/drug therapy*; Hypertension/genetics; Hypertension/pathology
  13. Ghazali DM, Rehman A, Abdul Rahman AR
    Clin Chim Acta, 2008 Feb;388(1-2):46-50.
    PMID: 17977523 DOI: 10.1016/j.cca.2007.10.002
    BACKGROUND: Knowledge of candidate gene polymorphisms in a population is useful for a variety of gene-disease association studies, particularly for some complex traits. A single nucleotide variant of the angiotensinogene gene (AGT M235T) and endothelial nitric oxide synthase gene (eNOS G894T) have been associated with hypertension.
    METHOD: A cross-sectional study consisting of 200 hypertensives and 198 age- and sex-matched controls was conducted. Subjects involved in this study were pure Malay for 3 generations. The AGT M235T and eNOS G894T polymorphisms were determined by PCR-RFLP method.
    RESULTS: The distribution of M235T genotype in the population was 3.5% for MM, 30.4% for MT and 66.1% for TT. No significant difference was observed in genotype (chi(2)=1.30, p=0.52) and allele (chi(2)=0.87, p=0.35) frequencies among the 2 study group. In contrast, the distribution of genotypes for G894T was 74.1% for GG, 24.6% for GT and 1.3% for TT, respectively. Similarly, no significant difference was observed in genotype (chi(2)=0.94, p=0.33) and allele (chi(2)=0.60, p=0.44) frequencies between both study groups.
    CONCLUSION: The AGT M235T and eNOS G894T polymorphisms are unlikely to play an important role in the pathogenesis of hypertension in Malays.
    Study site: Outpatient clinic, Hospital Universiti Sains Malaysia (HUSM); government clinics, Kelantan, Malaysia.
    Matched MeSH terms: Hypertension/genetics*; Hypertension/epidemiology*
  14. Lim TO, Ngah BA, Suppiah A, Ismail F, Abdul Rahman R
    Singapore Med J, 1991 Aug;32(4):245-8.
    PMID: 1776003
    Consecutive hypertensives admitted with cardiovascular complications were studied. One hundred and eight complicated hypertensives (10%) out of 1,066 medical admissions were seen in the three month study. Thirty three per cent had cerebrovascular disease, 30% ischaemic heart disease, 2% had malignant hypertension and 85% had hypertensive heart disease. All patients had uncontrolled hypertension at admission (mean blood pressure 184/115 mmHg). Twenty-four patients (22%) were newly diagnosed; of the rest of previously diagnosed hypertensives (78%), 3% had never been on treatment and 56% had dropped out of treatment, which explained their ineffective blood pressure control. However, 18% of patients had apparently been on regular follow up and treatment, and yet their blood pressure control was poor. Many patients had evidence of renal disease. The prevalence of cardiovascular risk factors was also high; 56% had hypercholesterolaemia; 46% had hypertriglyceridaemia; 44% smoked, 38% were overweight or obese, and 18% were diabetic. This indicates that hypertension is best regarded as an ingredient of a cardiovascular risk profile and its management requires multifactorial correction of all risk factors identified.
    Matched MeSH terms: Hypertension/complications*
  15. Zainudin LD, Abdul Hafidz MI, Zakaria AF, Mohd Zim MA, Ismail AI, Abdul Rani MF
    Respirol Case Rep, 2016 Mar;4(1):19-21.
    PMID: 26839696 DOI: 10.1002/rcr2.143
    We report a case of a 34-year-old lady with past history of asthma and pulmonary tuberculosis, who presented 5 weeks pregnant with acute dyspnea. Her chest X-ray showed left-sided complete lung collapse and concomitant right-sided pneumothorax. The pneumothorax was initially managed conservatively with a chest tube but due to its persistence despite suction, was subsequently changed to a Pneumostat(TM), with which she was later discharged. She had a normal echocardiography (ejection fraction [EF] 67%) at 5 weeks of gestation but developed pulmonary hypertension (EF 55%, pulmonary arterial pressure 40.7 mmHg) as the pregnancy progressed. She delivered a healthy baby at 35 weeks via elective lower section caesarean section with spinal anesthesia. We followed her up postnatally and noted the presence of left-sided pulmonary embolism, hypoplastic left lung, and left pulmonary artery. The management of this complex case involved a multidisciplinary effort between general medical, respiratory, obstetric, and cardiothoracic teams.
    Matched MeSH terms: Hypertension, Pulmonary
  16. Syer, Ree Tee, Xin, Yun Teoh, Wan Abdul Rahman Wan Mohd Aiman, Ahmad Aiful, Siu, Calvin Yee Har, Zi, Fu Tan, et al.
    MyJurnal
    Background: Hypertension is estimated to cause4.5% of the global disease burden. The prevalence of hypertension in Malaysia is 32.2%.
    Objective: To determine the prevalence of hypertension and its associated risk factors in two rural communities in Penang, Malaysia.
    Methods: This cross sectional study was conducted among all consenting residents aged 18 years and above from two villages in Penang. Besides the baseline demographic information, blood pressure was measured using a manual sphygmomanometer according to the American Heart Association Guidelines.
    Results: 50 out of 168 people were hypertensive, giving a prevalence rate of 29.8%. 50.0% of those found with hypertension were undiagnosed and 48.0% of those who were diagnosed with hypertension had uncontrolled blood pressure. Logistic regression analysis showed that age, history of alcohol consumption and BMI were found to be independently associated with hypertension.
    Conclusions: Age, education level, alcohol consumption and BMI are important risk factors associated with the prevalence of hypertension among the villagers. These risk factors are comparable to those reported in National Health and Morbidity Survery 2006 in Malaysia.
    Matched MeSH terms: Hypertension
  17. Shaik Alaudeen SR, Mohd Shah AS, Abdul Talib N, Abdullah A
    MyJurnal
    Introduction: Hypertension related morbidities and mortalities around the world show a gradual increase and early detection and prevention are advocated. The Database of Genomic Variants (DGV) has associated variation in DNA sequences called copy number variation (CNV) with susceptibility to common diseases. However, little is known about CNV role in essential hypertension. Thus, this study aimed to characterize the CNV esv27061 among prehypertensive and hypertensive young adults in Malaysia. Materials and method: In this comparative cross-sectional study, 104 subjects living in Kuantan who gave voluntary consent to participate are recruited and divided into three groups; control (43 subjects), prehypertensive (38 subjects) and mild hypertensive (23 subjects). An optimized droplet digital polymerase chain reaction (ddPCR) was used in the determination of CNV esv27061 in this study. Results: All subjects in the control (n=38; 88.4% gain), prehypertensive (n=33; 86.8% gain) and mild hypertensive (n=21; 91.3% gain) groups had CNV gain (copy number > 2) while 11.6% of control, 13.2% of prehypertensive and 8.7% of mild hypertensive subjects exhibited normal copies (copy number = 2). Conclusion: The present preliminary finding was consistent with the Database of Genomic Variants (DGV) which stated that CNV esv27061 showed more gain than loss.
    Matched MeSH terms: Hypertension
  18. Martin AG, Abdullah JY, Jaafar A, Ghani AR, Rajion ZA, Abdullah JM
    J Clin Neurosci, 2015 Apr;22(4):735-9.
    PMID: 25564264 DOI: 10.1016/j.jocn.2014.09.021
    Decompressive craniectomy (DC) is a surgical option in managing uncontrolled raised intracranial pressure refractory to medical therapy. The authors evaluate the addition of zygomatic arch (ZA) resection with standard DC and analyze the resulting increase in brain volume using three-dimensional volumetric CT scans. Measurements of brain expansion dimension morphometrics from CT images were also analyzed. Eighteen patients were selected and underwent DC with ZA resection. The pre- and post-operative CT images were analyzed for volume and dimensional changes. CT images of 29 patients previously operated on at the same center were retrieved from the picture archiving and communication system (PACS) and were similarly studied. The findings obtained from the two groups were compared and analyzed. Analysis from three-dimensional CT volumetric techniques revealed an significant increase of 27.97ml (95% confidence interval [CI]: 39.98-180.36; p=0.048) when compared with standard DC. Brain expansion analysis of maximum hemicraniectomy diameter revealed a mean difference of 0.82cm (95% CI: 0.25-1.38; p=0.006). Analysis of the ratio of maximum hemicraniectomy diameter to maximum anteroposterior diameter gave a mean difference of 0.04 (95% CI: 0.05-0.07; p=0.026). The addition of ZA resection to standard DC may prove valuable in terms of absolute brain volume gain. This technique is comparable to other maneuvers used to provide maximum brain expansion in the immediate post-operative period.
    Matched MeSH terms: Intracranial Hypertension/radiography; Intracranial Hypertension/surgery*
  19. Abu Bakar I, Shuaib IL, Mohd Ariff AR, Naing NN, Abdullah JM
    Asian J Surg, 2005 Jan;28(1):1-6.
    PMID: 15691788
    OBJECTIVE: Spontaneous intracranial haemorrhage constitutes 18-40% of all stroke cases. Indications for cerebral angiography to find underlying potentially treatable vascular abnormalities are not clear. This study determined which intracranial haemorrhage patients need cerebral angiography by correlating computed tomography (CT) findings, age and hypertension history with cerebral angiography findings.

    METHODS: A total of 54 patients (8-79 years) with intracranial haemorrhage who underwent both CT examination and six-vessel cerebral angiography were studied over a 2-year period. Cerebral angiography was repeated within 6 weeks if the first angiogram was negative.

    RESULTS: Angiography detected vascular lesions in 50% of cases (aneurysm 38.9% and arteriovenous malformation, AVM, 11.1%). In the aneurysm group, angiographic yield was 34.3% whereas in the AVM group, it was 37.9%. Subarachnoid haemorrhage (SAH) combined with other types of haemorrhage (such as intracerebral haemorrhage, ICH) was not significantly correlated with the likelihood of finding a vascular lesion, both aneurysm and AVM (p = 0.157). Age less than 50 years had significant correlation (p = 0.021) in the AVM group as well as in the aneurysm group (p < 0.001). A history of hypertension was associated with both aneurysm (p = 0.039) and AVM (p = 0.008). No patients with deep intracerebral haematoma had vascular lesions. The presence of an intravascular haemorrhage (IVH) had significant correlation with aneurysm (p = 0.008) but not AVM. There was no significant difference in mean age between patients with and without a vascular lesion (p = 0.134).

    CONCLUSION: Cerebral angiography is justified in patients with ICH accompanied by pure SAH (p = 0.001). Other factors associated with finding a vascular lesion were a history of hypertension and the presence of IVH. Diagnostic cerebral angiography is indicated for patients with ICH and SAH and IVH with a history of hypertension, regardless of age.

    Matched MeSH terms: Hypertension/epidemiology
  20. Kandasamy R, Tharakan J, Idris Z, Abdullah JM
    Surg Neurol Int, 2013;4:124.
    PMID: 24232072 DOI: 10.4103/2152-7806.119006
    BACKGROUND: A patient with refractory epilepsy due to underlying mesial temporal sclerosis underwent general anesthesia for an elective anterior temporal lobectomy and amgydalo-hippocampectomy. He was a known hypertensive and his blood pressure was well controlled on medication.

    CASE DESCRIPTION: Following induction of general anesthesia and subsequent opening of the craniotomy flap it was noted that the patient had a very swollen brain that herniated out of the dural defect. There was an underlying spontaneous intraparenchymal bleed encountered in the region of the left temporal lobe with associated subarachnoid hemorrhage within the sylvian fissure. The clot was evacuated and subsequently brain swelling reduced allowing us to proceed with the intended surgery. Despite the intracranial findings there was no overt abnormality in the hemodynamic status from the time of induction of anesthesia to the craniotomy opening excepting a mild nonsustained elevation of blood pressure at the outset.

    CONCLUSION: This case is of interest due to the fact that spontaneous intraparenchymal bleeding after induction of anesthesia has not been reported before in literature and should be considered in any patient in which brain swelling occurs in a setting of elective neurosurgery in which the primary lesion does not cause elevated intracranial pressure.

    Matched MeSH terms: Intracranial Hypertension
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