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  1. Fulltext Perception of hypertension management by patients and doctors in Asia: potential to improve blood pressure control
    Abdul Rahman AR, Wang JG, Kwong GM, Morales DD, Sritara P, Sukmawan R, et al.
    Asia Pac Fam Med, 2015;14(1):2.
    PMID: 25729324 DOI: 10.1186/s12930-015-0018-3
    BACKGROUND: Hypertension is one of the world's most common health conditions and is a leading risk factor for mortality. Although blood pressure can be modified, there is a large proportion of patients whose blood pressure remains uncontrolled. The aim of this study, termed Edvantage 360°, was to gain a deeper understanding of hypertension management in Asia from the perspective of patients and doctors, and to propose strategies to improve blood pressure control.
    METHODS: Conducted in Hong Kong, Indonesia, Malaysia, the Philippines, South Korea, Taiwan, and Thailand, Edvantage 360° was a mixed-methods observational study that used both qualitative and quantitative elements: qualitative interviews and focus groups with patients (N = 110), quantitative interviews with patients (N = 709), and qualitative interviews with doctors (N = 85).
    RESULTS: This study found that, although there is good understanding of the causes and consequences of hypertension among Asian patients, there is a lack of urgency to control blood pressure. Doctors and patients have different expectations of each other and a divergent view on what constitutes successful hypertension management. We also identified a fundamental gap between the beliefs of doctors and patients as to who should be most responsible for the patients' hypertension management. In addition, because patients find it difficult to comply with lifestyle modifications (often because of a decreased understanding of the changes required), adherence to medication regimens may be less of a limiting factor than doctors believe.
    CONCLUSIONS: Doctors may provide better care by aligning with their patients on a common understanding of successful hypertension management. Doctors may also find it helpful to provide a more personalized explanation of any needed lifestyle modifications. The willingness of the doctor to adjust their patient interaction style to form a 'doctor-patient team' is important. In addition, we recommend that doctors should not attribute ineffectiveness of the treatment plan to patient non-adherence to medications, but rather adjust the medication regimen as needed.
    KEYWORDS: Attitude to health; Hong Kong; Hypertension; Indonesia; Malaysia; Philippines; Qualitative research; South Korea; Taiwan; Thailand
    Matched MeSH terms: Hypertension
  2. Fulltext AT1 receptor blockade alters nutritional and biometric development in obesity-resistant and obesity-prone rats submitted to a high fat diet
    Smith PM, Hindmarch CC, Murphy D, Ferguson AV
    Front Psychol, 2014;5:832.
    PMID: 25120524 DOI: 10.3389/fpsyg.2014.00832
    Obesity is a chronic metabolic condition with important public health implications associated with numerous co-morbidities including cardiovascular disease, insulin resistance, and hypertension. The renin angiotensin system (RAS), best known for its involvement in cardiovascular control and body fluid homeostasis has, more recently, been implicated in regulation of energy balance. Interference with the RAS (genetically or pharmacologically) has been shown to influence body weight gain. In this study we investigated the effects of systemic AT1 receptor blockade using losartan on ingestive behaviors and weight gain in diet induced obese (DIO) rats. Prior to losartan administration (30 mg/kg/day) body weight gain remained constant within the DIO animals (3.6 ± 0.3 g/day, n = 8), diet resistant (DR) animals (2.1 ± 0.6 g/day, n = 8) and in the age-matched chow fed control (CHOW) animals (2.8 ± 0.3 g/day, n = 8), Losartan administration abolished body weight gain in animals fed a high fat diet (DIO: -0.4 ± 0.7 g/day, n = 8; and DR: -0.8 ± 0.3 g/day, n = 8) while chow fed animals continued to gain weight (2.2 ± 0.3 g/day, n = 8) as they had previously to oral administration of losartan. This decrease in daily body weight gain was accompanied by a decrease in food intake in the HFD fed animals. Following the removal of losartan, both the DIO and DR animals again showed daily increases in body weight gain and food intake which were similar to control values. Our data demonstrate that oral losartan administration attenuates body weight gain in animals fed a HFD whether the animal is obese (DIO) or not DR while having no effect on body weight gain in age-matched chow fed animals suggesting a protective effect of losartan against body weight gain while on a HFD.
    Matched MeSH terms: Hypertension
  3. Fulltext Effects of exercise training on postmenopausal hypertension: implications on nitric oxide levels
    Khalid T, Nesreen E, Ramadhan O
    Med J Malaysia, 2013 Dec;68(6):459-64.
    PMID: 24632913
    BACKGROUND: Postmenopausal hypertension is one of the leading causes of morbidity and mortality in women. Exercise training has been proved to decrease its risk factors and cardiovascular events. Aerobic exercise training stimulates endothelial nitric oxide release that acts as an antithrombotic and is cardiovascular protective. The effect of aerobic exercise training on postmenopausal hypertension is not fully elucidated.

    THE PURPOSE OF THE STUDY: to investigate the effects of moderate exercise training on nitric oxide levels in postmenopausal hypertension.

    METHODS: A prospective, randomized, controlled trial was conducted on 30 postmenopausal women involved in this study. The participants had at least one year's history of postmenopausal hypertension. Their ages ranged (40-50) years. Their body mass index ranged (30-36 Kg/m(2)). They were divided into two equal groups (treatment and control). Nitric oxide levels and blood pressure were measured in both groups in the initial examination at the beginning of the study, and at the end of the study. The treatment group received moderate aerobic exercise training. This ranged from 60-70% of maximum heart rate by walking on a treadmill at an average speed of 4km/hour for at least 20 minutes, three sessions a week, for 8 weeks.

    RESULTS: Body mass index, systolic and diastolic blood pressures were statistically significantly decreased. Nitric oxide levels were significantly increased in the treatment group. In this group the level of NO increased by 30.4% and systolic blood pressure decreased by 16.2%. Diastolic blood pressure decreased by 9.5% and body mass index decreased by 6%. In the control group the NO level increased by 8%. Systolic blood pressure decreased by 3% and diastolic blood pressure decreased by 3%.

    CONCLUSION: Exercise performed at moderate intensity for two months had obvious benefits in improving NO levels and controlling the hypertension in obese postmenopausal women.
    Matched MeSH terms: Hypertension
  4. Fulltext Holistic management of venous ulcers especially with endovenous laser treatment using 980nm laser in an ethnically diverse society
    Murli NL, Lee TC, Beh ML
    Med J Malaysia, 2013 Dec;68(6):453-8.
    PMID: 24632912 MyJurnal
    AIM: Chronic venous ulcers usually occur as an occupational hazard due to venous insufficiency with venous hypertension. Endovenous laser treatment (EVT) is used to treat varicose veins with venous ulcers and outcome including demography assessed in the different races.

    PROCEDURE: 145 lower limbs(right 39.3%, left 60.7%) with venous ulcers involving reflux of the great saphenous (132 cases) and / or small saphenous (57 cases) veins underwent EVT with 980 nm diode laser for single (123 cases) or both (11 cases) legs intervention. Supplementary procedures required multiple avulsions and / or sclerotherapy. Holistic advice of multilayered bandaging, graduated compression stockings, weight reduction and lifestyle changes enforced.

    RESULT: The average age with venous ulcers was 53.6 years.The mean BMI was 26.8 : the Chinese, Indian and Malay BMIs were 25.1, 28.1 and 31.3 respectively. Symptoms that included pain, swelling, heaviness and cramps assessed pre- and postsurgically were significantly reduced (<0.0001), using the Wilcoxan signed rank test. Of the occupations involved by race, the Chinese were mostly salespersons, Indians blue collar workers and Malays foodrelated workers. Young overweight Indians with sedentary occupations were most predisposed to venous ulcers. Gram negative organisms 63.4% and gram positive organisms 36.6% were isolated in the ulcers. Most ulcers 63.5% measured <2 cm and majority 73.8% localised in the gaiter area.

    DISCUSSION: Results of EVT in healing ulcers with no recurrences more than 2 years were successful in 89.7% (130/145). Complications included numbness foot 7.5% and DVT 1.4%. 10.3% (15 cases) had recurrence of venous ulcers within 2 years. In terms of satisfaction 32.3% experienced as very satisfied while 63.4% were satisfied and 4.3% unsatisfied. In conclusion EVT is a useful adjunct with with minimal invasion in managing venous ulcers holistically.
    Matched MeSH terms: Hypertension
  5. Prevalence and risk factors of non-alcoholic fatty liver disease in a multiracial suburban Asian population in Malaysia
    Goh SC, Ho EL, Goh KL
    Hepatol Int, 2013 Jun;7(2):548-54.
    PMID: 26201786 DOI: 10.1007/s12072-012-9359-2
    BACKGROUND: The prevalence of non-alcoholic fatty liver disease (NAFLD) in the Malaysian population is not known. Malaysia has a multiracial Asian population with three major Asian races: Malay, Chinese, and Indian living together. The aim of the study is to determine the prevalence and risk factors in a suburban Malaysian population.

    METHODS: Consecutive subjects who came for a health checkup at a suburban medical facility were recruited for the study. All individuals had clinical assessments, anthropometric measurements, blood tests, and ultrasonography of the liver performed. Those with significant alcohol consumption and history of chronic liver disease were excluded.

    RESULTS: Of the 1,621 "health screened" individuals analyzed, 368 (22.7 %) were found to have NAFLD. They comprised Chinese 1,269 (78.3 %), Malay 197 (12.1 %), and Indian 155 (9.6 %). Males and "older" age group ≥45 years had high prevalence rates with the highest in Indian (68.2 %) and Malay (64.7 %) males. Chinese females <45 years had the lowest prevalence of 5.2 %. A significant increase in the prevalence of fatty liver between age <45 years and ≥45 years was seen in female of all three races but in male, this increase was seen only among the Indians. NAFLD was strongly associated with diabetes mellitus, glucose intolerance, body mass index ≥23, low high-density lipoprotein cholesterol, hypertriglyceridemia, and hypertension.

    CONCLUSION: NAFLD is common in suburban Malaysian population. Older Indian and Malay males have an inordinately high prevalence of the disease.

    Matched MeSH terms: Hypertension
  6. Fulltext A retrospective review of diabetic nephropathy patients during referral to the sub-urban nephrology clinic
    Menon R, Mohd Noor FS, Draman CR, Seman MR, Ghani AS
    Saudi J Kidney Dis Transpl, 2012 Sep;23(5):1109-14.
    PMID: 22982937 DOI: 10.4103/1319-2442.100972
    Diabetic nephropathy (DN) has become the most common cause of end-stage renal failure. Early referral and specific nephrology treatment could delay the disease progression and should reduce the treatment cost, mortality and morbidity rate in these patients. This is a single-center, retrospective review of all DN patients referred to the nephrology clinic in Hospital Sultan Ahmad Shah, Temerloh, from 2000 to 2009, to study and define the clinical characteristics of DN patients at the time of the referral to the nephrology clinic. A total of 75 patient case records were reviewed. Forty-three (57.3%) of them were males, with a median age of 64.3 ± 8.5 years at the time of referral. Only 14.7% of them had blood pressure lower than 125/75 mmHg. Co-morbid and disease-related complications were also commonly diagnosed and 28.4% (n = 21) had ischemic heart disease, 23% (n = 17) had diabetic retinopathy and 20.3% (n = 15) had diabetic neuropathy. The mean serum creatinine at the time of referral was 339.8 ± 2.3 μmol/L, gylcated hemoglobin A 1c (HbA1C) was 8.1 ± 2.0 %, serum fasting glucose was 9.6 ± 4.7 mmol/L, serum cholesterol was 5.4 ± 1.2 mmol/L and hemoglobin level was 10.6 ± 2.9 g/dL. Although female patients were less frequently seen in the early stages of chronic kidney disease (CKD), they comprised at least 72.7% of CKD stage 5 (male:female; 6:16, P <0.05). Twenty-nine percent (n=22) of them were referred at CKD stage 5, 48% (n=36) were at CKD stage 4, 17.3% (n=13) were at CKD stage 3, 4% (n=3) were at CKD stage 2 and 1.3% (n=1) was at CKD stage 1. Advanced CKD patients were frequently prescribed with more antihypertensives. CKD stage 5 patients were prescribed with two-and-half types of antihypertensive as compared to two types of anti-hypertensive in CKD stage 2 and stage 3. Furthermore, ACE-inhibitors (ACE-I) were less frequently prescribed to them. Only 22.7% (n=5) of CKD stage 5 patients received ACE-I and 30% (n=11) in CKD stage 4 patients as compared to 53.4% (n=7) in CKD patients stage 3. This review shows that DN patients were referred late to the nephrologists and the overall disease management was suboptimal. Antihypertensive requirement was also increased and ACEIs were less frequently prescribed in the advanced diabetic nephropathy patients.
    Study site: Nephrology Clinic, Hospital Sultan Ahmad Shah, Temerloh, Pahang, Malaysia
    Matched MeSH terms: Hypertension/drug therapy; Hypertension/epidemiology; Hypertension/physiopathology
  7. Fulltext Adrenal cortical carcinoma masquerading as pheochromocytoma: a case report
    Ni H, Htet A
    Ecancermedicalscience, 2012;6:277.
    PMID: 23152728 DOI: 10.3332/ecancer.2012.277
    Adrenocortical carcinoma (ACC) is a malignant tumour arising from the adrenal cortex, while pheochromocytoma is a catecholamine secreting tumour of the adrenal medulla or extra adrenal sites. Both conditions are very rare, with incidence of approximately 1-2 cases per million adults annually. Most adrenocortical tumours are functioning. ACC can be associated with clinical Cushing syndrome and virilisation due to excessive production of cortisol and androgens, respectively. However, it is rare for ACC to present clinically as pheochromocytoma. We report a case of a 28-year-old lady who presented with paroxysmal hypertension and palpitations associated with raised urinary vanillyl mandelic acid. On examination, there was postural hypotension and ballotable mass in right lumbar region with no obvious features suggestive of Cushing syndrome or virilisation. A huge right suprarenal mass with areas of necrosis and calcification was noted on the abdomen CT. A right adrenalectomy was done. The histology was consistent with ACC. There are reported cases of ACC presenting with clinical features of pheochromocytoma but limited in number, accounting for barely a dozen cases in the literature. This pseudopheochromocytoma may be due to the presence of neuroendocrine features in ACC.
    Matched MeSH terms: Hypertension
  8. Fulltext Pregnancy with hypoplastic left lung complicated by pneumothorax and pulmonary embolism
    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
  9. Admissions with atrial fibrillation in a multiracial population in Kuala Lumpur, Malaysia
    Freestone B, Rajaratnam R, Hussain N, Lip GY
    Int J Cardiol, 2003 Oct;91(2-3):233-8.
    PMID: 14559136
    BACKGROUND: There are established differences in cardiovascular disease in different racial groups. Worldwide, the literature regarding the clinical epidemiology of atrial fibrillation in non-white populations is scarce.

    OBJECTIVES: To document the prevalence of atrial fibrillation (AF) in the multiracial population of Malaysia, and to describe the clinical features and management of these patients.

    SETTING: Busy city centre general hospital in Kuala Lumpur, Malaysia, over a 1-month period.

    SUBJECTS: One-thousand four hundred and thirty-five acute medical admissions, of whom 40 patients (2.8%) had AF.

    RESULTS: Of 1435 acute medical admissions to Kuala Lumpur General Hospital over the 4-week study period, 40 had AF (21 male, 19 female; mean age 65 years). Of these, 18 were Malay, 16 Chinese and six Indian. Nineteen patients had previously known AF (seven with paroxysmal AF) and 21 were newly diagnosed cases. The principal associated medical conditions were ischaemic heart disease (42.5%), hypertension (40%) and heart failure (40%). Dyspnoea was the commonest presentation, whilst stroke was the cause of presentation in only two patients. Investigations were under-utilised, with chest X-ray and echocardiography in only 62.5% of patients and thyroid function checked in 15%. Only 16% of those with previously diagnosed AF were on warfarin, with a further three on aspirin. Anticoagulant therapy was started in 13.5% of patients previously not on warfarin, and aspirin in 8%. Records of contraindications to warfarin were unreliable, being identified in only 25%. For those with known AF, 58% were on digoxin. For new onset AF, digoxin was again the most common rate-limiting treatment, initiated in 38%, whilst five patients with new onset AF were commenced on amiodarone. DC cardioversion was not used in any of the patients with new onset AF.

    CONCLUSION: Amongst acute medical admissions to a single centre in Malaysia the prevalence of AF was 2.8%. Consistent with previous similar surveys in mainly western (caucasian) populations, standard investigations in this Malaysian cohort were also inadequate and there was underuse of anticoagulation, medication for ventricular rate control and cardioversion to sinus rhythm.

    Matched MeSH terms: Hypertension/diagnosis; Hypertension/ethnology; Hypertension/therapy
  10. Predictors of Recurrent Ischemic Stroke in Obese Patients With Type 2 Diabetes Mellitus: A Population-based Study
    Albitar O, Harun SN, Abidin NE, Tangiisuran B, Zainal H, Looi I, et al.
    J Stroke Cerebrovasc Dis, 2020 Oct;29(10):105173.
    PMID: 32912507 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105173
    BACKGROUND: Diabetes and obesity are established risk factors for stroke. The current study aimed to assess risk factors of ischemic stroke recurrence in diabetic patients based on their body mass index (BMI).

    METHODS: A total of 4005 diabetic patients who had a history of ischemic stroke were identified in a retrospective cross-sectional dataset from the Malaysian National Neurology Registry. Patients were classified based on BMI, and multivariable regression analysis was used to evaluate the association between risk factors and recurrent ischemic stroke.

    RESULTS: Among obese patients, those with ischemic heart disease (aOR, 1.873; 95% CI, 1.131-3.103), received formal education (aOR, 2.236; 95% CI, 1.306-3.830), and received anti-diabetic medication (aOR, 1.788; 95% CI, 1.180-2.708) had a higher stroke recurrence risk, while receiving angiotensin receptors blockers (aOR, 0.261; 95% CI, 0.126-0.543) lowered the odds of recurrence. Overweight patients with hypertension (aOR, 1.011; 95% CI, 1.002-1.019) for over 10 years (aOR, 3.385; 95% CI, 1.088-10.532) and diabetes prior to the first stroke (aOR, 1.823; 95% CI, 1.020-3.259) as well as those received formal education (aOR, 2.403; 95% CI, 1.126-5.129) had higher odds of stroke recurrence, while receiving angiotensin-converting enzyme inhibitors (aOR, 0.244; 95% CI, 0.111-0.538) lowered the recurrence risk. Normal weight East Malaysians (aOR, 0.351; 95% CI, 0.164-0.750) receiving beta-blockers (aOR, 0.410; 95% CI, 0.174-0.966) had lower odds of stroke recurrence.

    CONCLUSIONS: Ischemic heart disease, hypertension, receiving anti-hypertensive agents, and educational level were independent predictors of recurrent stroke in obese patients. Managing the modifiable risk factors can decrease the odds of stroke recurrence.

    Matched MeSH terms: Hypertension
  11. Fulltext Prevalence of obesity, hypertension, and hyperglycemia among the rural community of Inanam sub-district in Kota Kinabalu, Sabah, Malaysia: a health screening program findings
    Khairul Anwar Zarkasi, Nur Zuliani Ramli, Vennila Gopal, Sadia Choudhury Shimmi, Anne Lolita Miranda, Wan Salman Wan Saudi, et al.
    Malaysian Journal of Medicine and Health Sciences, 2019;15(106):93-93.
    MyJurnal
    Introduction:Malaysia has the highest prevalence of obesity among the Southeast Asian nations which increases the risk for non-communicable diseases such as diabetes mellitus and hypertension. Since rural communities regularly face challenges in receiving medical services, regular health screening programs targeting these communities are necessary for early diagnosis and intervention to prevent complications as well as preserve the patients’ quality of life. Methods: A community health screening program was performed in the Inanam sub-district of Kota Kinabalu, Sa-bah, Malaysia. A total of 50 participants via convenience sampling were examined for body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) to determine their general and central obesity status. Estimation of body fat percentage (Fat%) and body fat mass was conducted by using bioelectrical impedance analysis. Addition-ally, systolic blood pressure (SBP), diastolic blood pressure (DBP), and capillary blood glucose were also measured. Results: The participants had a median age of 39.50 years. The prevalence of general obesity was 28%, while the prevalence of central obesity was 78% (based on WC) and 74% (according to WHR). Hypertension and hyperglyce-mia prevalence was reported at 24% and 20%, respectively. BIA showed that both Fat% and fat mass had positive associations with BMI (r=0.656, p=0.001 for Fat%; r=0.868, p=0.001 for fat mass) and WC (r=0.505, p=0.001 for Fat%; r=0.761, p=0.001 for fat mass). The DBP had positive associations with the BMI (r=0.390, p=0.005), WC (r=0.467, p=0.001), and WHR (r=0.331, p=0.019), while the SBP had a positive association with the WC alone (r=0.341, p=0.015). Conversely, there were no significant associations between capillary blood glucose and BMI, WC, or WHR. Conclusion: The rural community of Inanam sub-district had a higher prevalence of central obesity than the national level. This should raise concern among healthcare professionals regarding future hypertension and hyperglycemia risk in this community.
    Matched MeSH terms: Hypertension
  12. Fulltext Improvement of nutritional intake for the low-income urban dwellers with hypertension in Malaysia
    Azizan NA, Majid HA, Nahar Mohamed A, Su TT
    SAGE Open Med, 2020;8:2050312120960563.
    PMID: 33014371 DOI: 10.1177/2050312120960563
    Objective: To ascertain the effect of dietary practice modification and a peer-support home blood pressure monitoring program on the nutritional intake (macronutrients and micronutrients), blood pressure and biochemical profiles of hypertension patients in a low-income community setting.

    Methods: This is a pre- and post-measurement intervention study conducted in low-income community housing projects in Kuala Lumpur, Malaysia. A total of 90 participants aged 18 years and above with hypertension received intervention. The participants were divided into small groups and received instructions on the use of home blood pressure measurement. They also attended a series of talks on dietary intake modification and exercise demonstration for the first six months (active phase). In another 6 months (maintenance phase), they received only pamphlet and SMS reminders. Their anthropometry, blood pressure, dietary, and biochemical parameter changes were measured at baseline, 6 months, and 12 months of intervention.

    Results: Macronutrients and micronutrients showed a significant improvement at the end of 12-month dietary intervention. The energy, carbohydrate, protein, total fat, sodium, and potassium are showing significant reduction from baseline to end of the 12-month intervention. There is no significant reduction in blood pressure. Fasting blood glucose, renal sodium, triglyceride, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol showed a significant improvement, after controlling for age and reported physical activity.

    Conclusion: The intervention improved the nutritional intake and biochemical profiles of the low-income urban population with hypertension. This promising result should be replicated in a larger scale study.

    Matched MeSH terms: Hypertension
  13. Perceived Illness and Treatment Adherence to Hypertension Among Patients Attending a Tertiary Hospital in Kathmandu, Nepal
    Shakya R, Shrestha S, Gautam R, Rai L, Maharjan S, Satyal GK, et al.
    Patient Prefer Adherence, 2020;14:2287-2300.
    PMID: 33244224 DOI: 10.2147/PPA.S270786
    Introduction: Hypertension (HTN) is a silent killer, accountable for life-threatening complications. An individual's illness perception may affect adherence to treatment which is crucial to prevent complications of HTN. The objective of this study was to identify illness perception and treatment adherence among patients with HTN in a tertiary hospital in Kathmandu, Nepal.

    Methods: Descriptive correlational study was conducted in the out-patient department of Manmohan Cardiothoracic Vascular and Transplant Center, Kathmandu Nepal. Non-probability purposive sampling was used. A face-to-face interview was conducted from September to December 2018, using a structured questionnaire that included socio-demographic variables, illness perception questionnaire (revised) and Hill bone compliance to high blood pressure therapy scale. Data analysis was done by using descriptive and inferential statistics (chi-square test, Spearman rank correlation).

    Results: Among 204 participants, 51% were male, 77% were literate, mean ± S.D. age was 60±12. About 72% experienced headache and 88% said that headache is related to HTN. Behavioural factors and psychological factors were regarded as the leading cause of HTN. Almost 63% participants believed HTN as highly threatening illness. Higher scores in timeline (acute/chronic), personal control, and treatment control revealed that patients believed HTN as a chronic disease with a higher rate of personal and treatment control. Regarding treatment adherence, the mean score was 16.58 (SD = 2.08), and only 14.7% had perfect adherence. Participants were more adherent to medication and appointment keeping rather than reduce salt intake. Duration of HTN diagnosis (p=0.027) and duration under HTN medication (p= 0.021) were found to be significantly associated with treatment adherence. There was a significant positive correlation between illness perception and treatment adherence (ρ = 0.282, p<0.01).

    Conclusion: Illness perception and treatment adherence are correlated. Hence, it is beneficial to improve illness perception to achieve perfect treatment adherence. Reinforcement is essential to maintain adherence to both medications and behaviour therapy.

    Matched MeSH terms: Hypertension
  14. Fulltext Comparison of WIFi, University of Texas and Wagner Classification Systems as Major Amputation Predictors for Admitted Diabetic Foot Patients: A Prospective Cohort Study
    Vera-Cruz PN, Palmes PP, Tonogan L, Troncillo AH
    Malays Orthop J, 2020 Nov;14(3):114-123.
    PMID: 33403071 DOI: 10.5704/MOJ.2011.018
    Introduction: Classifications systems are powerful tools that could reduce the length of hospital stay and economic burden. The Would, Ischemia, and Foot Infection (WIFi) classification system was created as a comprehensive system for predicting major amputation but is yet to be compared with other systems. Thus, the objective of this study is to compare the predictive abilities for major lower limb amputation of WIFi, Wagner and the University of Texas Classification Systems among diabetic foot patients admitted in a tertiary hospital through a prospective cohort design.

    Materials and Methods: Sixty-three diabetic foot patients admitted from June 15, 2019 to February 15, 2020. Methods included one-on-one interview for clinico-demographic data, physical examination to determine the classification. Patients were followed-up and outcomes were determined. Pearson Chi-square or Fisher's Exact determined association between clinico-demographic data, the classifications, and outcomes. The receiver operating characteristic (ROC) curve determined predictive abilities of classification systems and paired analysis compared the curves. Area Under the Receiver Operating Characteristic Curve (AUC) values used to compare the prediction accuracy. Analysis was set at 95% CI.

    Results: Results showed hypertension, duration of diabetes, and ambulation status were significantly associated with major amputation. WIFi showed the highest AUC of 0.899 (p = 0.000). However, paired analysis showed AUC differences between WIFi, Wagner, and University of Texas classifications by grade were not significantly different from each other.

    Conclusion: The WIFi, Wagner, and University of Texas classification systems are good predictors of major amputation with WIFi as the most predictive.

    Matched MeSH terms: Hypertension
  15. Universal Coverage of Hypertension Treatment Services in Malaysia Is Still an Elusive Goal
    Ng CW, Shahari MR, Mariapun J, Hairi NNM, Rampal S, Mahal A
    Health Syst Reform, 2017 Jul 03;3(3):159-170.
    PMID: 31514671 DOI: 10.1080/23288604.2017.1342746
    An analysis of population coverage of hypertension treatment services can be used to make inferences about the performance of primary care services within health systems. Malaysia, an upper middle-income country, has a well-established primary care system but one that favors rural populations and provision of services for maternal and child health and infectious diseases. Demographic factors including rapid aging, urbanization, as well as lifestyle changes characteristic of a modernizing society have led to an increase in noncommunicable diseases, including hypertension. In this article, we used data from a nationally representative household health survey to develop service coverage indicators for hypertension screening and treatment services. The age-standardized prevalence of hypertension was estimated to be 33.9% (95% confidence interval [CI], 33.9, 33.9). Only 39.0% (95% CI, 37.5, 40.6) of adults with hypertension had been diagnosed by a medical practitioner, 35.7% had been on treatment, and 9.6% had blood pressure controlled under treatment. The diagnosis, treatment, and controlled treatment coverage were higher for older persons compared to younger persons. There were no differences in the diagnosis and treatment coverage between urban and rural areas and between ethnic groups. However, controlled treatment coverage was higher among Chinese and those living in urban areas. Our findings suggest that primary care services in Malaysia may need to intensify health education activities to promote screening services. There is also a need to reprioritize activities to provide regular community health screening of adults and increase access to affordable primary care services, especially in the urban areas.
    Matched MeSH terms: Hypertension
  16. Fulltext A cross-sectional study of hypertensive outpatients to determine the necessity of asking about erectile dysfunction symptoms
    Sharifuddin N, Abdul Aziz AF, Sheikh Hamzah M, Abdul Rashid R, Zainuddin Z, Wan Puteh SE, et al.
    South African Family Practice, 2011;53:384-389.
    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
  17. Clinical experience in using CD20 monoclonal antibody in treating severe systemic lupus erythematosus
    Mohd Shahrir MS, Abdul Halim AG, Soehardy Z, Kong NCT
    APLAR Journal of Rheumatology, 2007;10(2):112-116.
    DOI: 10.1111/j.1479-8077.2007.00270.x
    Background and method: This clinical experience involved the treatment of resistant systemic lupus erythematosus (SLE) patients with CD20 monoclonal antibody. Five patients failed conventional therapy, two developed complications and one needed rituximab as an emergency measure. Four patients had lupus nephritis, three had autoimmune hemolytic anemia, two had immune thrombocytopenia and one had lupoid hepatitis. The patients were aged 14-49 years, (mean 28.63). Three were Malays, two Chinese, two Indian and one Turkish; six were females. Mean disease duration was 63.25 months and mean total rituximab dose received was 2812.50 mL. Results: Hemoglobin levels improved from 9.3 ± 5.7 to 13.1 ± 8.6 g/dL for two SLE patients with autoimmune hemolytic anemia after 34 weeks (P = 0.180). Platelet counts improved from 25 ± 17 to 198 ± 97 × 10 9/high powered field from 0 to 10 weeks for three SLE patients with immune thrombocytopenia (P = 0.109). In the lupus nephritis patients on rituximab, serum albumin improved from 24.5 ± 23.2 to 37.5 ± 31.8 mmol/L (n = 3) from week 0 to week 17 (P = 0.100). Urine protein creatinine ratio improved from 0.55 ± 0.23 to 0.08 ± 0.03 g/mmol creatinine (P = 0.068) from week 0 to week 13. C3 and C4 improved from 90.8 ± 36.5 to 120.7 ± 37.9 (P = 0.07) and 21.6 ± 10.1-27.3 ± 16.2 mg/dL (P = 0.27), respectively, and Systemic Lupus Erythematosus Activity Disease Index was reduced from 17.9 ± 11.2 to 6.3 ± 6.8 (P = 0.375) after 8 weeks. Two patients developed drug reactions to rituximab. Conclusion: All of the patients responded to rituximab on top of their conventional therapy. © 2007 Asia Pacific League of Associations for Rheumatology and Blackwell Publishing Asia Pty Ltd.
    Matched MeSH terms: Hypertension
  18. Blood pressure profile for children aged 5 to 6 years and its associated factors - a cross-sectional study in Kuching district, Sarawak
    Cheah WL, Edmund Shin CV, Ayu Akida AR
    Malays Fam Physician, 2019;14(1):2-9.
    PMID: 31289625
    Introduction: This study aimed to determine the blood pressure profile for preschool children in Kuching Sarawak and its relationship with sociodemographic characteristics, nutritional status and parental hypertension.

    Methods: This was a cross sectional study conducted in a government preschool in Kuching district from January to June 2017. Data were collected using questionnaire as well as anthropometric and blood pressure measurements. Data were entered into and analyzed using SPSS Version 22.

    Results: A total of 229 preschool children participated in this study (response rate of 81%). About 9.7% of the respondents were at risk for hypertension. The mean systolic blood pressure was 95.6 mmHg (SD=8.36), and the mean diastolic blood pressure was 59.9 mmHg (SD=6.09). Ten percent of the children were overweight and 7.4% were obese. Binary logistics regression analysis indicated that gender (Male: OR = 3.085, p< 0.05), parent's education level (comparing primary education and below with secondary education: OR = 4.88, p<0.05; comparing primary education and below tertiary education: OR = 7.63, p<0.05) and ethnicity (comparing Malay with Chinese: OR = 0.10, p< 0.01) were significantly associated with being at risk for hypertension.

    Conclusion: The study showed that 9.7% of the children were at risk for hypertension and that 17.4% had abnormal body weights. Identifying and tackling the factors leading to these issues will help to improve and ensure a better quality of non-communicable disease programs offered in primary health clinics and school health programs.

    Matched MeSH terms: Hypertension
  19. Fulltext Prevalence and associated factors of metabolic syndrome among menopausal women in a tertiary center, Malaysia
    Hussain NHN, Hamid HA, Kadir AA, Musa KI, Ismail SB
    International Journal of Collaborative Research on Internal Medicine and Public Health, 2012;4:1285-1296.
    Introduction: Metabolic syndrome (MetS) is a condition that includes the presence of a cluster of risk factors specific for cardiovascular disease (CVD). The criteria used to aid the diagnosis of MetS includes abdominal obesity, elevated triglycerides, low high density lipoprotein (HDL) cholesterol, hypertension or use of antihypertensive medication, elevated fasting blood glucose and other risk factors. Objective: This study aimed to determine the prevalence of metabolic syndrome (MetS) among postmenopausal women and its associated factors in a tertiary center in Malaysia Methods: This is a cross-sectional study done among 411 postmenopausal women attending Gynaecology clinic and Family Medicine clinic in a tertiary center in Malaysia. Socio demographic data, reproductive profile, menopausal profile and medical history were obtained. Then waist circumference (WC), weight, height and blood pressure (BP) were also recorded. A fasting blood sample was obtained for serum glucose and lipid profile determinations. Metabolic syndrome was defined according to the criteria of International Diabetes Federation. Results: The mean age of participants was 57.2 + 6.9 years. The prevalence of metabolic syndrome was 36.7%. The risk of MetS increased with the presence of obstetrics history of hypertension (HPT) (odds ratio (OR) 2.64, 95% (CI) 1.25-5.62), previous usage of contraception (odds ratio (OR) 1.56, 95% (CI) 1.02-2.42), family history of HPT (odds ratio (OR) 1.71, 95% (CI) 1.13-2.59) and obesity (odds ratio (OR) 2.59, 95% (CI) 1.08-6.23). Conclusion: There was a high prevalence of the metabolic syndrome in postmenopausal women seeking gynaecologic and primary health care in the tertiary center Malaysia. The associated factors of MetS include previous obstetrics history of HPT, family history of HPT and obesity.
    Matched MeSH terms: Hypertension
  20. Fulltext Prevalence of prehypertension and its associated factors among adults visiting outpatient clinic in Northeast Malaysia
    Rafan SN, Zakaria R, Ismail SB, Muhamad R
    J Taibah Univ Med Sci, 2018 Oct;13(5):459-464.
    PMID: 31435362 DOI: 10.1016/j.jtumed.2018.06.005
    Objectives: Prehypertension refers to a systolic blood pressure of 120-139 mmHg systolic or a diastolic blood pressure of 80-89 mmHg. Estimation of the prevalence of prehypertension in the population and identification of cardiovascular associated factors are important to reduce progression to hypertension. This study aimed to determine the prevalence of prehypertension and its associated factors among Malaysian adults.

    Methods: In 2015, a cross-sectional study was conducted among adults visiting an outpatient clinic in Northeast Malaysia. Face-to-face interviews were conducted using Malay and English versions of the Malaysia Non-Communicable Disease surveillance questionnaire. This instrument captured information about sociodemographic, lifestyle status, and anthropometric data. Blood pressure was measured three times with a sphygmomanometer, the first measurement value was discarded, and an average of blood pressure from the second two readings was recorded for further data analysis. Logistic regression was performed to analyse factors associated with prehypertension.

    Result: A total 151 adults participated in the study, and the prevalence of prehypertension was 37.1% (95% confidence interval [CI]: 29.29, 44.69). Factors associated with prehypertension in this study were age (adjusted odds ratio [aOR] = 1.06 95% CI: 1.02, 1.11; p = 0.007), male sex (aOR = 4.44 95% CI: 1.58, 12.44; p = 0.005), and abnormal waist circumference (aOR = 31.65 95% CI: 11.25, 89.02; p 

    Matched MeSH terms: Hypertension; Prehypertension
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