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Fulltext Prevalence of cardiovascular disease risk factors among attendees of the Batu 9, Cheras Health Centre, Selangor, Malaysia

Amplavanar NT, Gurpreet K, Salmiah MS, Odhayakumar N

Med J Malaysia, 2010 Sep;65(3):173-9.
PMID: 21939163 MyJurnal

This study describes the prevalence of selected cardiovascular disease (CVD) risk factors screened in patients 30 years and above attending a health centre in Cheras, Selangor. The study involved 3772 patients screened from March 2002 to June 2008. Risk factors screened included blood pressure, height, weight, serum total cholesterol, random blood sugar levels and smoking status. Majority of respondents were between 40 and 49 years of age (58.1%), males (64.7%) and ethnic Malays (74.4%). About two thirds (62.6%) were found to be overweight or obese, two fifths (40.2%) had hypercholesterolemia, a third (34.2%) had hypertension and 31.6% were smokers at some time. Overall 87% and 60% had at least one and two CVD risk factors respectively. Prevalence of four of the five risk factors screened was highest among the Malay middle aged men and lowest among the Chinese. Thus a substantial proportion of middle aged men were at high risk of CVD. Our findings show the need for ongoing monitoring of CVD risk factors and implementation of effective preventive strategies.

Matched MeSH terms: Hypertension/epidemiology
Mutational analysis of CYP2C8 in hypertensive patients using denaturing high performance liquid chromatography

Teh LK, Zahri MK, Zakaria ZA, Ismail R, Salleh MZ

J Clin Pharm Ther, 2010 Dec;35(6):723-8.
PMID: 21054465 DOI: 10.1111/j.1365-2710.2009.01146.x

CYP2C8 is involved in the cytochrome P450 (CYP) epoxygenase pathway. Arachidonic acid metabolites such as epoxyeicosatrienenoic acids and hydroxyeicosatetrenoic acids, produced may have a role in hypertension. We aimed to develop a medium through-put method for screening samples of known and new mutations of CYP2C8 using denaturing high performance liquid chromatography (DHPLC).

Matched MeSH terms: Hypertension/genetics*
Maternal plasma soluble fms-like tyrosine kinase-1 and placental growth factor levels as biochemical markers of gestational hypertension for Malaysian mothers

Nadarajah VD, Min RG, Judson JP, Jegasothy R, Ling EH

J Obstet Gynaecol Res, 2009 Oct;35(5):855-63.
PMID: 20149032 DOI: 10.1111/j.1447-0756.2009.01037.x

To establish baseline levels of maternal plasma soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) among normotensive Malaysian mothers and to compare the marker levels between normotensives and mothers with gestational hypertension (GH).

Matched MeSH terms: Hypertension, Pregnancy-Induced/blood*
Fulltext Selecting antihypertensive medication in patients with essential hypertension in Malaysia

Ong HT, Rozina G

Med J Malaysia, 2009 Mar;64(1):3-11.
PMID: 19852313 MyJurnal

Since hypertension is generally asymptomatic, in treating hypertension we are actually seeking to prevent target organ damage and reduce adverse clinical outcome. There have been numerous large clinical trials addressing the question of whether any antihypertensive drug has special protective effects on the cardiovascular and renal systems in addition to the benefit from blood pressure (BP) reduction1-15. In seeking to correctly interpret the message from these trials, it is important to avoid the confusion that can occur when pharmaceutical companies seek to make the results suit their marketing needs 16-18. The aim of this article is thus to provide an unbiased review of the value of the different antihypertensive drugs for the clinician treating essential hypertension in Malaysia.

Matched MeSH terms: Hypertension/drug therapy*
Systemic sclerosis in Sarawak: a profile of patients treated in the Sarawak General Hospital

Teh CL, Kuan YC, Wong JS

Rheumatol Int, 2009 Aug;29(10):1243-5.
PMID: 19373465 DOI: 10.1007/s00296-009-0938-z

We performed a cross-sectional study of the demography, clinical and laboratory features of patients with systemic sclerosis patients followed up in our centre from 1984 to 2007. There were 23 cases with the majority of them (96%) being female. They have a mean age of 50.3 years and a mean disease duration of 6.02 (SD 5.82) years. Our patients comprised of multi-ethnic groups with predominantly Chinese (52%), Sarawak natives (35%) and Malays (13%). They have a mean lag time to diagnosis of 24.8 (SD 34.8) months. All the patients have sclerodermatous skin changes with 16(70%) having diffuse scleroderma and 7(30%) having limited scleroderma. The common clinical manifestations found in our patients were Raynaud's phenomenon (91%), sclerodactyly (65%), digital ulcers (52%) and pulmonary fibrosis (52%). There was low incidence of pulmonary hypertension (13%) and renal involvement (4%). The majority of our patients (67%) have positive ANA with 33% positive Scl-70. The majority received calcium channel blockers (87%), aspirin (48%) and low-dose prednisolone (48%). One patient developed adenocarcinoma of the lung on follow-up. This study demonstrated the rarity of systemic sclerosis in our centre with considerable lag time to diagnosis in our patients. Diffuse cutaneous systemic scleroderma is more common in our centre with rare pulmonary hypertension and renal involvement.

Matched MeSH terms: Hypertension, Pulmonary/diagnosis*
Stent dislodgement in left anterior descending coronary artery and successful deployment with two parallel wires and a small balloon

Ngow H

Kardiol Pol, 2009 Sep;67(9):1040-2 discussion 1043.
PMID: 19838965

Coronary artery stent dislodgement during angioplasty is a rare complication. Stent dislodgement was more frequent in the past when stents were manually crimped onto the balloon. Newer and improved balloon-mounted stents with better radio-opacity have reduced the incidence of stent dislodgement but do not completely eliminate it. We report a case of balloon-mounted stent dislodgement in the proximal left anterior descending (LAD) coronary artery prior to deployment. This patient however was successfully treated with re-wiring of the artery with two parallel wires and the stent's reposition prior to deployment with the help of a small balloon.

Matched MeSH terms: Hypertension/complications
Post traumatic cerebral oedema in severe head injury is related to intracranial pressure and cerebral perfusion pressure but not to cerebral compliance

Nujaimin U, Saufi A, Rahman AG, Badrisyah I, Sani S, Zamzuri I, et al.

Asian J Surg, 2009 Jul;32(3):157-62.
PMID: 19656755

This was a prospective cohort study, carried out in the Neuro Intensive Care Unit, Department of Neurosciences, Hospital Universiti Sains Malaysia, Kubang Kerian Kelantan. The study was approved by the local ethics committee and was conducted between November 2005 and September 2007 with a total of 30 patients included in the study. In our study, univariate analysis showed a statistically significant relationship between mean intracranial pressure (ICP) as well as cerebral perfusion pressure (CPP) with both states of basal cistern and the degree of diffuse injury and oedema based on the Marshall classification system. The ICP was higher while CPP and compliance were lower whenever the basal cisterns were effaced in cases of cerebral oedema with Marshall III and IV. In comparison, the study revealed lower ICP, higher mean CPP and better mean cerebral compliance if the basal cisterns were opened or the post operative CT brain scan showed Marshall I and II. These findings suggested the surgical evacuation of clots to reduce the mass volume and restoration of brain anatomy may reduce vascular engorgement and cerebral oedema, therefore preventing intracranial hypertension, and improving cerebral perfusion pressure and cerebral compliance. Nevertheless the study did not find any significant relationship between midline shifts and mean ICP, CPP or cerebral compliance even though lower ICP, higher CPP and compliance were frequently observed when the midline shift was less than 0.5 cm. As the majority of our patients had multiple and diffuse brain injuries, the absence of midline shift did not necessarily mean lower ICP as the pathology was bilateral and even when after excluding the multiple lesions, the result remained insignificant. We assumed that the CT brain scan obtained after evacuation of the mass lesion to assess the state basal cistern and classify the diffuse oedema may prognosticate the intracranial pressure and cerebral perfusion pressure thus assisting in the acute post operative management of severely head injured patients. Hence post operative CT brain scans may be done to verify the ICP and CPP readings postoperatively. Subsequently, withdrawal of sedation for neurological assessment after surgery could be done if the CT brain scan showed an opened basal cistern and Marshall I and II coupled with ICP of less than 20 mmHg.

Matched MeSH terms: Intracranial Hypertension/etiology
Fulltext "Postpartum morbidity--what we can do"

Zainur RZ, Loh KY

Med J Malaysia, 2006 Dec;61(5):651-6.
PMID: 17623974

Postpartum is a crucial period for a mother. During this period a mother is going through the physiological process of uterine involution and at the same time adapting to her new role in the family. Many postpartum complications occur during this period. Among the important obstetric morbidities are postpartum hemorrhage, pregnancy related hypertension, pulmonary embolism and puerperal sepsis. Common surgical complications are wound breakdown, breast abscess and urinary fecal incontinence. Medical conditions such as anemia, headache, backache, constipation and sexual problems may also be present. Unrecognized postpartum disorders can lead to physical discomfort, psychological distress and a poor quality of life for the mothers. Providing quality postnatal care including earlier identification of the problems (correction) and proper intervention will help the mother to achieve full recovery and restore her functional status back to the pre-pregnancy state sooner.

Matched MeSH terms: Hypertension, Pregnancy-Induced/therapy
Duration of hypertension and antihypertensive agents in correlation with the phases of female sexual response cycle

Latif RA, Muhamad R, Ann AY, Sidi H, Nik Jaafar NR, Midin M, et al.

Compr Psychiatry, 2014 Jan;55 Suppl 1:S7-12.
PMID: 23206495 DOI: 10.1016/j.comppsych.2012.10.008

This cross-sectional study aimed to determine the construct of the phases of the female sexual response cycle (SRC) in women with hypertension and their association with the duration of hypertension and types of antihypertensive agents.

Matched MeSH terms: Hypertension/drug therapy*
Fulltext Pharmaceutical care issues identified by pharmacists in patients with diabetes, hypertension or hyperlipidaemia in primary care settings

Chua SS, Kok LC, Yusof FA, Tang GH, Lee SW, Efendie B, et al.

BMC Health Serv Res, 2012;12:388.
PMID: 23145922 DOI: 10.1186/1472-6963-12-388

BACKGROUND: The roles of pharmacists have evolved from product oriented, dispensing of medications to more patient-focused services such as the provision of pharmaceutical care. Such pharmacy service is also becoming more widely practised in Malaysia but is not well documented. Therefore, this study is warranted to fill this information gap by identifying the types of pharmaceutical care issues (PCIs) encountered by primary care patients with diabetes mellitus, hypertension or hyperlipidaemia in Malaysia.
METHODS: This study was part of a large controlled trial that evaluated the outcomes of multiprofessional collaboration which involved medical general practitioners, pharmacists, dietitians and nurses in managing diabetes mellitus, hypertension and hyperlipidaemia in primary care settings. A total of 477 patients were recruited by 44 general practitioners in the Klang Valley. These patients were counselled by the various healthcare professionals and followed-up for 6 months.
RESULTS: Of the 477 participants, 53.7% had at least one PCI, with a total of 706 PCIs. These included drug-use problems (33.3%), insufficient awareness and knowledge about disease condition and medication (20.4%), adverse drug reactions (15.6%), therapeutic failure (13.9%), drug-choice problems (9.5%) and dosing problems (3.4%). Non-adherence to medications topped the list of drug-use problems, followed by incorrect administration of medications. More than half of the PCIs (52%) were classified as probably clinically insignificant, 38.9% with minimal clinical significance, 8.9% as definitely clinically significant and could cause patient harm while one issue (0.2%) was classified as life threatening. The main causes of PCIs were deterioration of disease state which led to failure of therapy, and also presentation of new symptoms or indications. Of the 338 PCIs where changes were recommended by the pharmacist, 87.3% were carried out as recommended.
CONCLUSIONS: This study demonstrates the importance of pharmacists working in collaboration with other healthcare providers especially the medical doctors in identifying and resolving pharmaceutical care issues to provide optimal care for patients with chronic diseases.
TRIAL REGISTRATION: ClinicalTrials.gov NCT00490672.
Study name: Cardiovascular Risk Factors Intervention Strategies (CORFIS) trial

Matched MeSH terms: Hypertension/drug therapy*
Arterial embolization of a bleeding gastric Dieulafoy lesion: a case report

Mohd Rizal MY, Kosai NR, Sutton PA, Rozman Z, Razman J, Harunarashid H, et al.

Clin Ter, 2013;164(1):25-7.
PMID: 23455738 DOI: 10.7417/T.2013.1506

Dieulafoy's lesion is one of an unusual cause of upper gastrointestinal bleeding (U GIB). Endoscopic intervention has always been a preferred non-surgical method in treating UGIB including bleeding from Dieulafoy's lesion. Owing to recent advances in angiography, arterial embolization has become a popular alternative in non- variceal UGIB especially in cases with failed endoscopic treatment. However, managing bleeding Dieulafoy's with selective arterial embolization as the first line of treatment has not been exclusively practiced. We hereby, report a case of bleeding Dieulafoy lesion which had been primarily treated with arterial embolization.

Matched MeSH terms: Hypertension/complications
Acute Stroke Registry Malaysia, 2010-2014: Results from the National Neurology Registry

Aziz ZA, Lee YY, Ngah BA, Sidek NN, Looi I, Hanip MR, et al.

J Stroke Cerebrovasc Dis, 2015 Dec;24(12):2701-9.
PMID: 26338106 DOI: 10.1016/j.jstrokecerebrovasdis.2015.07.025

Stroke remains a major health burden worldwide. The incidence and prevalence rates of stroke are decreasing in developed countries, an opposite trend is taking place in the Asia Pacific, where an increasing number of patients are being diagnosed with acute stroke. The results of the present study on acute stroke in multi-ethnic Malaysia will significantly contribute to the global stroke epidemiological data. We aimed to present epidemiological data of stroke including incidence and prevalence rates as well as associated risk factors from a prospective nationwide hospital-based registry from 2010 to 2014.

Matched MeSH terms: Hypertension/complications
Fulltext Profound sustained hypotension following renal denervation: a dramatic success?

Sridhar GS, Watson T, Han CK, Ahmad WA

Arq. Bras. Cardiol., 2015 Aug;105(2):202-4.
PMID: 26352181 DOI: 10.5935/abc.20150100
Matched MeSH terms: Hypertension/surgery*
Perceived involvement and preferences in shared decision-making among patients with hypertension

Mah HC, Muthupalaniappen L, Chong WW

Fam Pract, 2016 06;33(3):296-301.
PMID: 26993483 DOI: 10.1093/fampra/cmw012

BACKGROUND: Shared decision-making (SDM) is an important component of patient-centred care. However, there is limited information on its implementation in Malaysia, particularly in chronic diseases such as hypertension.
OBJECTIVE: The objective of this study was to examine perceived involvement and role preferences of patients with hypertension in treatment decision-making.
METHODS: A cross-sectional survey was conducted among 210 patients with hypertension in a teaching hospital in Malaysia.
RESULTS: The majority of respondents agreed that their doctor recognized that a decision needs to be made (89.5%) and informed them that different options are available (77.1%). However, respondents' perceived level of involvement in other aspects of treatment decision-making process was low, including in the selection of treatment and in reaching an agreement with their doctor on how to proceed with treatment. In terms of preferred decision-making roles, 51.4% of respondents preferred a collaborative role with their physicians, 44.8% preferred a passive role while only 1.9% preferred an active role. Age and educational level were found to be significantly related to patient preferences for involvement in SDM. Younger patients (<60 years) and those with higher educational level preferred SDM over passive decision-making (ρ < 0.01). Encouragement from health care providers was perceived as a major motivating factor for SDM among patients with hypertension, with 91% of respondents agreeing that this would motivate their participation in SDM.
CONCLUSION: Preferences for involvement in decision-making among patients with hypertension are varied, and influenced by age and educational level. Physicians have a key role in encouraging patients to participate in SDM.

Matched MeSH terms: Hypertension/therapy*
Fulltext Association of TNF-α G308A gene polymorphism in essential hypertensive patients without type 2 diabetes mellitus

Ghodsian N, Akhlaghi M, Ramachandran V, Heidari F, Haghvirdizadeh P, Eshkoor SA, et al.

Genet. Mol. Res., 2015 Dec 29;14(4):18974-9.
PMID: 26782547 DOI: 10.4238/2015.December.29.4

This study aims to investigate the effects of tumor necrosis factor alpha (TNF-α) G308A gene polymorphism on essential hypertension (EHT) with or without type 2 diabetes mellitus (T2DM). The project was conducted on buccal epithelial and blood cells for case and control patients, respectively. Epithelial cells were obtained from the inner part of the cheeks. Techniques including DNA extraction, polymerase chain reaction (PCR), and restriction fragment length polymorphism (RFLP) were utilized to assess biomarkers of DNA damage. Our results demonstrated significant differences between wild and mutated genotypes among EHT patients without T2DM. We also found a significant association between wild and mutated allele frequencies in EHT patients (P < 0.05). Clinical characteristics between the groups (EHT with or without T2DM and controls) showed statistically significant association (P < 0.05). Overall, we show that G308A polymorphism of the TNF-αgene may be a significant genetic risk factor for EHT without T2DM patients in Malaysia.

Matched MeSH terms: Hypertension/genetics*
Fulltext Understanding the modifiable health systems barriers to hypertension management in Malaysia: a multi-method health systems appraisal approach

Risso-Gill I, Balabanova D, Majid F, Ng KK, Yusoff K, Mustapha F, et al.

BMC Health Serv Res, 2015;15:254.
PMID: 26135302 DOI: 10.1186/s12913-015-0916-y

The growing burden of non-communicable diseases in middle-income countries demands models of care that are appropriate to local contexts and acceptable to patients in order to be effective. We describe a multi-method health system appraisal to inform the design of an intervention that will be used in a cluster randomized controlled trial to improve hypertension control in Malaysia.

Matched MeSH terms: Hypertension/drug therapy*
Fulltext Psychiatric disorder in Malaysians with systemic lupus erythematosus

Chin CN, Cheong I, Kong N

Lupus, 1993 Oct;2(5):329-32.
PMID: 8305928 DOI: 10.1177/096120339300200510

All 79 patients who attended a University Systemic Lupus Erythematosus (SLE) Clinic over a 6 month period were assessed using the Clinical Interview Schedule for psychiatric disorder. Using the ICD-9 Classification, 40 were found to have psychiatric disorder, 26 having depressive neurosis, six anxiety neurosis, five endogenous depression and three dementia. The group with psychiatric disorder had significantly poor family support as well as lack of a confidant compared to the group without psychiatric disorder (P < 0.01). There was no difference between the group with psychiatric disorder and those without psychiatric disorder in terms of age, duration of illness, ethnicity and severity of SLE. Psychiatric disorder is common affecting more than half the subjects and depression was the most frequent diagnosis.
Study site: SLE clinics, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia

Matched MeSH terms: Hypertension/complications
Fulltext Once daily felodipine monotherapy in mild to moderate hypertension

Kon SP, Tan HW, Chua CT, Ong ML, Kamsiah J, Maheendran KK, et al.

Med J Malaysia, 1992 Dec;47(4):290-6.
PMID: 1303482

In a single-blind study conducted at our centres, 78 hypertensive patients were enrolled with 58 completing the study according to the protocol. Mean supine and standing blood pressures were significantly reduced after treatment with felodipine, reductions being 27/21 mmHg (p < 0.0001) and 25/19 mmHg (p < 0.0001) respectively. Of 46 patients given felodipine 5 mg, 44 (95.7%) achieved target blood pressure defined as a diastolic blood pressure of < 90 mmHg, while all 12 patients on felodipine 10 mg did so. The 2 patients who did not achieve target pressure at the final visit did so on previous visits. There were no differences in pre and post-treatment laboratory variables. Treatment was discontinued in 6 patients because of headaches. No adverse events of clinical significance were reported in the 58 patients who completed the study. In conclusion, we found felodipine given once daily to be effective in the treatment of mild to moderate hypertension.

Study site: Multicentre

Matched MeSH terms: Hypertension/drug therapy*
Chronic pyelonephritis: the significance of renal renin and the vascular changes in the human kidney

Peh SC, Lindop GB

J Pathol, 1991 Apr;163(4):343-9.
PMID: 2033493

Hypertension complicates chronic pyelonephritis. Since arterial narrowing is common in the damaged kidney, activation of the renin-angiotensin system due to renal ischaemia has been suggested as a pathogenetic mechanism. We used an antiserum to human renin and an immunoperoxidase technique to study the anatomy of renin-containing cells (RCC) in 18 kidneys removed for pyeloneophritis. We independently assessed the degree of arterial narrowing and correlated these variables with the clinical findings. There was histological evidence of hyperplasia of RCC in 5 of the 6 hypertensive patients and in 7 of the 12 non-hypertensive cases. There was no difference in the apparent number or distribution of RCC between the hypertensive and the non-hypertensive cases. Also, the degree of arterial narrowing did not correlate with either the hyperplasia of RCC or the blood pressure of the patients. Our results do not support the hypothesis that narrowing of the intrarenal arteries is important in the pathogenesis of hypertension in pyelonephritis. In our cases, the renal veins were more severely damaged than the arteries and their lumina were often obliterated by organized thrombus. We suggest that such widespread obliteration of the renal venous tree could impair blood flow and contribute to the tissue damage in the pyelonephritic kidney.

Matched MeSH terms: Hypertension, Renal/etiology*
Trends in selected obstetric complications from University Hospital, Kuala Lumpur, Malaysia

Zulkifli SN, Paine LL, Greener DL, Subramaniam R

Int J Gynaecol Obstet, 1991 May;35(1):29-36.
PMID: 1680072

Trends in selected pregnancy complications from 1969 to 1987 in a tertiary hospital in Malaysia are presented. Complications reviewed were abortion, ectopic pregnancy, anemia, hypertension, hyperemesis, antepartum and postpartum hemorrhage. Possible explanations for the observed trends were discussed, including the role of improved obstetric care and changes in the characteristics of the childbearing population. The data presented give some indication of maternal morbidity in the childbearing population served by this tertiary center and should lead to improvements in provision of services as well as in health data collection in the future.

Matched MeSH terms: Hypertension/epidemiology

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