Introduction: In Malaysia, cardiovascular diseases (CVD) have been the leading cause of death for the past 40 years. Hypertension is the leading treatable risk factor for CVD mortality.
Objectives: to determine the prevalence and factors associated with hypertension among University Putra Malaysia staff.
Methods: A Cross sectional study design was used in this study. The sample was selected using table of random numbers. Two blood pressure measurements were taken from respondents aged 30 years and above. Data on socio-demographic variables and lifestyle-related risk factors were collected using a pre-tested structured questionnaire. Weight and height measurements were also taken.
Results: Out of 517 respondents selected, 454 subjects agreed to participate, giving a response rate of 87.8%. The overall mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) for 454 respondents was 126.2 mmHg and 80.17 mmHg respectively. The mean SBP was significantly higher in males (129.68 mmHg) as compared to the females (122.65 mmHg). The mean SBP and DBP significantly increased with age in both males and females (p<0.05). There was a significant relationship between SBP and BMI (r = 0.55, r2 = 0.30 p <0.001) and diastolic blood pressure and BMI (r = 0.53, r2 = 0.28, p <0.001). The overall prevalence of hypertension was 34.4% and 33.9% had pre hypertension. Hypertension was significantly associated with age, gender, family history of hypertension, BMI and alcohol consumption. Conclusions: Prevalence of hypertension and pre-hypertension is high. There is an urgent need for implementation of a comprehensive CVD prevention program. Routine blood pressure measurements should be taken to improve the detection, prevention and treatment of hypertension.
Keywords: Hypertension, Prevalence, Risk Factors, University Staff, Prevalence
Introduction Special Olympics (SO) Inc. is an organization for people with intellectual disability (ID) to actively engaging in Olympic-type sport and participating in competition. Special Olympic Inc. provides Healthy Athletes Programme (HAP®) in screening and providing health education to Special Olympic Athletes. Objective To study the body mass index (BMI), blood pressure (BP), visual acuity and hearing status of children and young adult with ID in Special Olympics Sarawak. Methods Health data were collected by trained health professionals under HAP®held in conjunction with Special Olympics Sarawak State Games on 17th and 18th April 2010 in Sibu. Health data collected were athletes' weight, BMI, BP, ear canal screen and hearing status (oto-acoustic emission, pure tone audiometry), as well as eye health and visual acuity, using guidelines set by HAP®. Results 195 athletes attended the State Games in 2010 of which 138 were screened. Significant number of athletes was considered overweight / obese (31.5% for children and 36.9% for adult). More than 20% of the adult athletes were hypertensive or at risk of hypertension. Sixteen percent of the adult athletes had hearing loss. More than half of the adult and children athletes never had eye checks, and a significant numbers of them had abnormal eye tests results. Conclusions Health screening conducted during the HAP® is a useful screening program in this population. Health data collected can bring awareness to athletes and their family, and corrective measures in hearing and visual impairment can be taken immediately.
Introduction : Stillbirth is one of the important adverse pregnancy outcomes that has been used as a health indicator for the measurement of the health status of a country especially for its obstetric care management. However, the aetiology of the occurrence of the stillbirth was commonly difficult to identify because of limitations in the classification system.
Methods : A review of existing, available information published up to January 2007 on stillbirths in Malaysia was used to obtain the basic background on the determinant factors of stillbirths. Results : Malaysia, which is a fast developing country, reported a stillbirth rate in the range of 4 to 5 per 1000 births. Almost 30- 40% were recorded as normally formed macerated stillbirths. This was based on a rapid reporting system of perinatal deaths using the modified version of the Wigglesworth’s pathophysiology classification. Those of extreme maternal age (less than 19 years and more than 35 years), those reside in rural areas, of the ‘Bumiputera’ and Indian ethnic groups were at higher risk of stillbirth. On detailed analysis it was seen that the risks of having a normally formed macerated stillbirth increased among those who had a preterm delivery and hypertension. Stillbirth rates were also higher in those with shorter gestational age and in those with parity between 2 and 5. No other factors related to stillbirth were found in this review.
Conclusion : This is a review based on existing published data which has a lot of limitation when it comes to analysing other important factors that might be related with the risk of the stillbirth. However, extreme maternal age and mothers from rural areas are the two factors that were persistently found in almost all literature. When these factors are combined with signs of pre term delivery, they indicate that close monitoring needs to be done.
Background : The management of chronic disease during flood seems to be one of the main challenges to the health care service. Chronic disease becomes worst during flood. Poor condition at the relief centres, loss of assets, fear, and lack of functional health facilities contribute to the morbidity and mortality during and after flood. Poor chronic disease management, especially on severe and uncontrolled hypertension, may threaten lives of victims during flood. In addition, comprehensive treatment cannot be delivered due to destroyed infrastructure, shortage of doctors on duty and delay in getting drug supply. Therefore, all aspects of chronic disease management shall be reviewed and included in the disaster preparedness in order to control and prevent acute incidence and complications of the chronic diseases. Previous Action Plan did not address this issue effectively which had caused many patients not getting their treatment adequately. The aim of this writing is to share experiences in managing chronic disease patients particularly hypertensive patients.
Methodology : A retrospective study based on data collection by health personnel while conducting health screening, clinical examination and giving treatment to flood victims at the relief centres. Hypertensive patients were identified when the victims came for treatment and while the medical team conducting medical rounds. New hypertensive cases as well as uncontrolled cases with no complication were treated and monitored at the relief centres.
Result : It was found that 34,530 cases of non communicable disease (11.1% of the total number of the flood victims) including hypertension and diabetes mellitus were reported in Johor. Kota Tinggi reported a total number of 5,317 cases of chronic disease. There was no data collection on specific chronic diseases collected at the state level during the floods thus the findings representing Kota Tinggi cases only. In retrospective search of 150 flood victims with hypertension in Kota Tinggi, only 95 cases had complete data. Among them 71.6% (68 cases) were hypertensive cases already on treatment and 28.4% (27 cases) were new cases. Also it has been found that 67.4% (64 cases) were uncontrolled hypertension and 32.6% (31 cases) were controlled hypertension. Four cases had been found diagnosed as uncontrolled hypertension with complications and have been referred to hospital.
Conclusion : Comprehensive health strategy for flood victims shall not be focused only on saving lives and giving emergency treatment to patients but also to update and strengthen an overall chronic disease management. Many factors contributed to increase in blood pressure during flooding. Good hypertensive treatment at the relief centres is needed to minimise morbidity and mortality. Information on care and treatment received by flood victims having chronic disease is vital in assessing their health needs during disaster and in formulating disaster preparedness in the future.
There is concern that shift workers are at higher risk for metabolic syndrome (MS) . The syndrome is characterized by a constellation of metabolic risk factors in one individual. A cross-sectional study of 148 workers in one factory in Kota Bharu, Kelarttan was conducted to examine relationships between shift work and five of the MS rnk factors namely high blood pressure, hyperglycemia, hypertriglyceridaemia, hypo·I·IDL-cholesterolaemia and high body mass index (BMI) . Data was collected through a questionnaire on psychosocial and life-style factors, anthropometric and blood pressure measurements, fasting blood sugar and fasting lipid profile. The National Cholesterol Education Program’s Adult Treatment Panel III Report (NCEPATP III) with some modifications was used to determine the presence of risk factors for the metabolic syndrome, The prevalence of high blood pressure, hypertriglyceridaemia and high BMI were significantly higher among shift workers compared to day workers. There was no difference in the prevalence of hyperglycemia and hypo-HDL-cholesterolaemia. When the shift workers were compared with the
day workers, the proportion of workers having three or more risk factors for the syndrome was higher among shift workers which were 15.8% and 5.6% respectively.
Obesity is a major health concern and the growing rate raises important issues specific to concurrent rise of the related diseases especially hypertension. This study aimed to determine the relationship between hypertension and obesity based on body mass index and waist circumference besides relevant sociodemographic factors according to gender specific analysis. The analysis is important to determine in depth insight of two genders. This cross-sectional study was conducted among community in Tanjung Karang, Selangor, Malaysia in 2009 and included a total of 439 male and 668 female respondents aged 18-59 years old. Data was collected by interview-guided questionnaire and anthropometric measurements. SPSS version 21.0 was used for analysis of the relationship between socio demographic factors, smoking, body mass index and waist circumference with hypertension. Finally logistic regression analysis was used to assess the predictors of hypertension according to gender. The prevalence of hypertension was 25.5% in males and 23.1% in females, giving a total of 24%. Significantly higher prevalence of hypertension was found in overweight and obese categories (42.2% and 60.5% in males; 39.5% and 48.9% in females). Those with abdominal obesity also had significantly greater risk in having hypertension (41.6% in males and 33.2% in females). The logistic regression analysis indicated that age, high BMI and abdominal obesity were significantly associated with hypertension in women, and on the other hand age and BMI only for men. Both obesity and abdominal obesity are significantly important predictors of hypertension in females but BMI obesity only in males. Effective weight management strategies targeting obese people and abdominally obese women should be implemented in order to prevent hypertension and related cardiovascular diseases.
Introduction: Ambulatory blood pressure accurately reflects a patient's actual blood pressure than casual or office blood pressure. This study aims to describe the circadian blood pressure profile of hypertensive patients and to identify the associated cardiovascular risk factors in non-dippers.
Methods: A cross-sectional study was conducted from 1st January 2008 to 30th June 2008 among hypertensive patients attending Family Medicine Clinic HUSM. Schiller BR-102 plus was used to get 24 hours blood pressure (BP) reading. Mean of two offices BP were also taken. Non-dippers are defined as a systolic or diastolic nocturnal drop of less than 10%. Analysis was done using SPSS Version 12.
Results: 105 patients were recruited with mean (SD) age of 51.8 (9.34) year old. The mean (SD) 24-hour systolic and diastolic BP was 128.4 (12.7) mmHg and 79.7 (8.74) mmHg respectively. Mean (SD) daytime systolic and diastolic BP was 132.1 (11.72) mmHg and 82.4 (9.41) mmHg while for the night time were 123.3 (12.78) mmHg and 76.2 (9.01) mmHg. Mean (SD) systolic and diastolic office BP was 144.2(15.16) mmHg and 90.2(9.71) mmHg. Percentage of non dippers were 68.6% for systolic and 61.9% for diastolic.
Conclusion: Mean 24 hours and daytime ambulatory BP was normal but the mean night time diastolic and office BP was above-normal value. Majority of the patients were categorized as non dippers. Therefore, using ambulatory BP is clinically important to get a better understanding of blood pressure fluctuations over 24-hour periods compared to simple clinical measurements.
Study site: Family Medicine Clinic, Hospital Universiti Sains Malysia (HUSM), Kelantan, Malaysia
Cardiovascular diseases (CVD) are the leading cause of mortality in Malaysia as well as in other countries. It is associated with many risk factors, such as increasing age, hypertension, diabetes, dyslipidemia, oxidative stress and autonomic dysfunction and arterial stiffness. The objectives of this study were to measure the prevalence of arterial stiffness and to assess its association with dyslipidemia. Methods: A cross sectional study was conducted in a rural community in Malaysia involving 146 subjects. Data were collected using an interviewer administered questionnaire which included three sections – sociodemographic characteristics, personal profile, and past medical history. In addition, Seca Body Meter (Seca 220) was used to measure height and weight. Sphygmomanometer (OMRON Automatic Blood Pressure Monitor HEM 907) and SphygmoCor-AtCor MM3 SERIAL/RS-232 were used for blood pressure and augmentation index (AIx) measurement. Data were analysed using the SPSS for Windows, Version 18.0. Results: The mean age of respondents was 49.5 years, SD±15.6. The prevalence of arterial stiffness was 23.3% (95% Confidence Interval (CI): 16.44 – 30.16). The prevalence of dyslipidemia was 82.9% (95% CI: 76.79 – 89.01). Multivariate logistic regression revealed that total cholesterol was significantly associated with arterial stiffness (OR=4.56, CI 1.10-18.90). Conclusion: The prevalence of dyslipidemia was high. Despite an insignificant association between dyslipidemia and AIx, there is a significant association between TC level and AIx.
A clinical descriptive study was done to determine the sociodemographic, laboratory and clinical characteristics of patients with congenital adrenal hyperplasia (CAH) referred to Hospital Putrajaya, a tertiary endocrine centre in Malaysia. Electronic laboratory data of 51 CAH patients were obtained. The demographics and clinical details of the study population were acquired from a questionnaire completed by parents of participants. There were 25 males (49%) and 26 females (51%), of which, 58.8% were Malays. Median age of participants was 4 years whilst median age at diagnosis of CAH was two years. Parental consanguinity was documented in three patients (5.9%). Patients originated from Johor (19.6%), Selangor (19.6%), Negeri Sembilan (17.6%) and Kedah (13.7%). Majority of patients were diagnosed after one week of life (80.4%) although more females were diagnosed under the age of one week compared to males (p=0.041). Most females presented with ambiguous genitalia (42.3%) [p=0.001] whereas 72% of males presented with salt wasting (p=0.003). No significant associations between race and all other variables, though interestingly three Malay patients presented with ambiguous genitalia and hypertension. Equal gender distribution noted as expected in an autosomal recessive condition, although not in keeping with other Asian countries. Early diagnosis in females attributed to obvious genital ambiguity at birth. Varied clinical presentation, although in minority, necessitates genetic studies for prompt diagnosis and treatment. Considering that majority of patients presented with salt wasting and the age at diagnosis was delayed, the introduction of a neonatal screening programme is essential in Malaysia.
The diagnosis of tuberculous meningitis (TBM) demands a high index of suspicion. The prognosis depends on the stage of the disease the diagnosis is made and how early the treatment is instituted. The outcome of the disease is very poor when the diagnosis and treatment are late. This is what happened to this child, a 7-year-old Malay girl who presented at stage III TBM. The diagnosis was confirmed by a positive culture of M. tuberculosis from the cerebrospinal fluid (CSF). The delay in the diagnosis in this child had catastrophic consequences. She had hydrocephalus at presentation; however ventricular drainage was not done because parental consent was not obtained. She was started on acetazolamide and frusemide, and daily lumbar puncture in an attempt to reduce the raised intracranial pressure (ICP) in addition to anti-tuberculous chemotherapy. However when she showed no improvement, an external lumbar drain was inserted. The CSF was checked daily and the level of protein and glucose became normal after 6 weeks. The CT scan showed improvement of the hydrocephalus. However, the girl remained severely disabled after treatment and had to be fed via nasogastric tube and needed constant nursing care.
Background : Study of stress among adults in rural community is seldom been conducted and this study aims to see the prevelence of the stress among this group of population.
Methodology : A cross sectional study was conducted to measure the prevalence of stress among the rural people in Hulu Langat District, Selangor using O`Donnell Personal Stress Inventory and coping mechanism practiced by them.
Result : A total of 265 respondents through universal sampling participated in this study. The stress prevalence identified was 16.2%. The factors which have significant association with stress were age, education level, marital status, working women, duration of working per day and body mass index. Diseases such as diabetis mellitus and hypertension showed no association with stress. Preferred coping mechanism used by respondents included emotional support, instrumental support, behavior modification and denial.
Conclusion : Stress among the rural population is high in Malaysia. Measures has to be taken to reduce the stress as it can effect the general health of the people.
Background & Objective: Posterior reversible encephalopathy syndrome (PRES) is associated with
immunosuppressive agents used in children with haemato-oncological diseases. There are no reports
to date from the South Asia and South East Asia region. We report a Malaysian tertiary centre case
series of children with haemato-oncological disease who developed PRES. Methods: Retrospective
study of children seen with haemato-oncology diseases seen at the University Malaya Medical Centre
Kuala Lumpur who developed PRES from 2011 – 2013. Clinical details were obtained from medical
records and brain neuroimaging was reviewed. Results: Five patients met the inclusion criteria. All
5 patients had significant hypertension acutely or subacutely prior to neurology presentation. Four
presented with acute seizures and the remainder 1 presented with encephalopathy.Three patients
were on chemotherapy, 1 had renal impairment and 1 had prior immunosupression for bone marrow
transplantation. A full recovery was seen in 4 patients and 1 patient had mild residual quadriplegia.
Conclusion: Our case series expands the clinico-radiological spectrum of PRES in children with
underlying haemato-oncological disorders. It is the first to show that prior cyclosporin intake as long
as 2 months is a potential risk factor for PRES. Clinicians need to be vigilant for development of
PRES and closely monitor the blood pressure in these children who are receiving or recently had
immunosuppressive drugs and present with acute neurological symptoms.
BACKGROUND:Stroke is a leading cause of death and disability, especially in low-income and middle-income countries. We sought to quantify the importance of potentially modifiable risk factors for stroke in different regions of the world, and in key populations and primary pathological subtypes of stroke.
METHODS:We completed a standardised international case-control study in 32 countries in Asia, America, Europe, Australia, the Middle East, and Africa. Cases were patients with acute first stroke (within 5 days of symptom onset and 72 h of hospital admission). Controls were hospital-based or community-based individuals with no history of stroke, and were matched with cases, recruited in a 1:1 ratio, for age and sex. All participants completed a clinical assessment and were requested to provide blood and urine samples. Odds ratios (OR) and their population attributable risks (PARs) were calculated, with 99% confidence intervals.
FINDINGS: Between Jan 11, 2007, and Aug 8, 2015, 26 919 participants were recruited from 32 countries (13 447 cases [10 388 with ischaemic stroke and 3059 intracerebral haemorrhage] and 13 472 controls). Previous history of hypertension or blood pressure of 140/90 mm Hg or higher (OR 2·98, 99% CI 2·72-3·28; PAR 47·9%, 99% CI 45·1-50·6), regular physical activity (0·60, 0·52-0·70; 35·8%, 27·7-44·7), apolipoprotein (Apo)B/ApoA1 ratio (1·84, 1·65-2·06 for highest vs lowest tertile; 26·8%, 22·2-31·9 for top two tertiles vs lowest tertile), diet (0·60, 0·53-0·67 for highest vs lowest tertile of modified Alternative Healthy Eating Index [mAHEI]; 23·2%, 18·2-28·9 for lowest two tertiles vs highest tertile of mAHEI), waist-to-hip ratio (1·44, 1·27-1·64 for highest vs lowest tertile; 18·6%, 13·3-25·3 for top two tertiles vs lowest), psychosocial factors (2·20, 1·78-2·72; 17·4%, 13·1-22·6), current smoking (1·67, 1·49-1·87; 12·4%, 10·2-14·9), cardiac causes (3·17, 2·68-3·75; 9·1%, 8·0-10·2), alcohol consumption (2·09, 1·64-2·67 for high or heavy episodic intake vs never or former drinker; 5·8%, 3·4-9·7 for current alcohol drinker vs never or former drinker), and diabetes mellitus (1·16, 1·05-1·30; 3·9%, 1·9-7·6) were associated with all stroke. Collectively, these risk factors accounted for 90·7% of the PAR for all stroke worldwide (91·5% for ischaemic stroke, 87·1% for intracerebral haemorrhage), and were consistent across regions (ranging from 82·7% in Africa to 97·4% in southeast Asia), sex (90·6% in men and in women), and age groups (92·2% in patients aged ≤55 years, 90·0% in patients aged >55 years). We observed regional variations in the importance of individual risk factors, which were related to variations in the magnitude of ORs (rather than direction, which we observed for diet) and differences in prevalence of risk factors among regions. Hypertension was more associated with intracerebral haemorrhage than with ischaemic stroke, whereas current smoking, diabetes, apolipoproteins, and cardiac causes were more associated with ischaemic stroke (p<0·0001).
INTERPRETATION: Ten potentially modifiable risk factors are collectively associated with about 90% of the PAR of stroke in each major region of the world, among ethnic groups, in men and women, and in all ages. However, we found important regional variations in the relative importance of most individual risk factors for stroke, which could contribute to worldwide variations in frequency and case-mix of stroke. Our findings support developing both global and region-specific programmes to prevent stroke.
FUNDING: Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, Canadian Stroke Network, Health Research Board Ireland, Swedish Research Council, Swedish Heart and Lung Foundation, The Health & Medical Care Committee of the Regional Executive Board, Region Västra Götaland (Sweden), AstraZeneca, Boehringer Ingelheim (Canada), Pfizer (Canada), MSD, Chest, Heart and Stroke Scotland, and The Stroke Association, with support from The UK Stroke Research Network.
Pre-hypertension increased the risk of morbidity and mortality from non-communicable diseases. Whereas, psychological factors such as depression, anxiety and stress have been associated with increased in blood pressure. However, previous studies more focuses on psychological determinants of hypertension than prehypertension. Thus, this study aims to determine the association between these psychological factors with pre-hypertension. A cross-sectional study was conducted in 2012 among first year students of a public Malaysian university. A random cluster sampling was used to select 5 out of 15 faculties and a total of 495 students participated in this study. The Malay version of DASS-21 was used to elicit their levels of depression, anxiety and stress. Blood pressures were measured twice using sphygmomanometer and the averages were taken. Data analyses used chi-square test and binary multiple logistic regression. The prevalence of pre-hypertension was 30.1%. The percentage of severe and extremely severe depression was 3.8% and 1.2%; both severe and extremely severe anxiety was 16.4%; and severe and extremely severe stress was 4.2% and 0.2% respectively. Severe/extremely severe depression had more than 3 times higher in getting pre-hypertension than no depression. In conclusions, almost one third of respondents had pre-hypertension and only severe/extremely depression was associated with pre-hypertension.
Objective To determine the prevalence of diseases and its association with the sociodemographic factors (age, sex and ethnicity) among elderly patients admitted to a tertiary hospital in Malaysia.
Design A cross sectional study was conducted at various wards in the year of 2002. There were 9 333 respondents in this study selected by universal sampling. Setting A tertiary hospital in Malaysia. Main outcome measures Association between sociodemographic factors and prevalence of diseases. Results The mean age of the respondents was 68.9 + 6.8 years. Majority of the respondents were male (53.3%), Malays (43.7%) and married (73.2%). The prevalence of neoplasm was 15.5% followed by cataract (7.2%), diabetes mellitus (5.0%), hypertension (4.7%) and anemia (0.5%). There were significant association between gender and hypertension, diabetes mellitus, anemia and cataract (p
Night work and rotating shift work are found to be detrimental to the health of workers. A cross sectional analytical study was conducted among the employees of a public medical centre in Kuala Lumpur. A total of 380 employees participated in the health screening and questionnaire survey. The majority of the respondents were Malays, females, and with mean age of 49 years old. The shift workers persistently had higher but non-significant proportions of being overweight/obesity and unhealthy clinical indicators such as systolic and diastolic blood pressure, fasting blood glucose and lipid profile except waist circumferences and HDL-cholesterol. There were also slightly more shift workers diagnosed with diabetes mellitus, hypertension or coronary heart disease (p>0.05). Although the present study could not provide established evidence for a relationship between shift work and cardiovascular risks, this could serve as a pilot study for future studies in this area.
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.
Urinary tract infections frequently affect pregnant mothers. This problem causes significant morbidity and healthcare expenditure. Three common clinical manifestations of UTIs in pregnancy are: asymptomatic bacteriuria, acute cystitis and acute pyelonephritis. Escherichia coli remains the most frequent organism isolated in UTIs. All pregnant mothers should be screened for UTIs in pregnancy and antibiotics should be commenced without delay. Urine culture and sensitivity is the gold standard in diagnosing UTIs. Without treatment, asymptomatic bacteriuria in pregnancy is associated with preterm delivery, intrauterine growth retardation, low birth weight, maternal hypertension, pre-eclampsia and anaemia. Acute pyelonephritis can lead to maternal sepsis. Recurrent UTIs in pregnancy require prophylactic antibiotic treatment.
Hypertension is a prevalent chronic disease, which is strongly related to the development of cerebrovascular and cardiovascular diseases. The prevalence of hypertension in Malaysia in subjects aged 15 years and above was estimated to be 27.8%. Cost-effectiveness analysis (CEA) compares treatment options with different effectiveness and safety profiles. The utilisation of antihypertensive drugs has raised some concerns about the balance between its costs and benefits. This study was conducted to describe the healthcare costs for hypertensive subjects and to examine the cost-effectiveness of different classes of antihypertensive drugs used in Malaysia. Retrospective and prospective data analysis of a cohort of uncomplicated hypertensive patients was conducted to determine ambulatory health care costs among hypertensive patients groups. The total direct and
indirect costs of controlled and uncontrolled blood pressure (BP) were described. The health care
costs ($) / clinical outcome (AC/E ratio) was calculated. Mean total direct costs per patient per month was higher in uncontrolled blood pressure groups compared to the controlled blood pressure groups. The cost-effectiveness relationship was more favourable for diuretics (1.9), angiotensin converting enzyme inhibitors (ACEIs) (2.0), prazosin (2.4) and beta blockers (2.5), more than the diuretics and beta blockers combination theraphy (3.0), calcium channel blockers (CCBs) (3.4) and other combinations (6.1). Antihypertensive drugs used to treat hypertensive patients were different
in their cost-effectiveness ratios. Such results will allow health care professionals and/or decision
makers to make better decisions on how to select treatment options for hypertensive patients in
Malaysia and how to distribute and allocate scarce health care resources. Pharmacoeconomic
evaluations can help in making difficult choices rationally and allocate scarce resources efficiently.
This study aimed to review the risk factors and clinical outcomes of patients undergoing pars planar vitrectomy (PPV) for breakthrough bleeding (BTB) from age related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV). We performed a retrospective review of medical records of 346 patients operated by the vitreoretinal unit at Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia from January 2008 - June 2011. We found eight eyes of 8 patients with AMD/IPCV-related BTB who underwent PPV. Mean age of patients was 64.4 years (range 41-80 years) with 5 males. Five were Chinese. Duration of symptoms ranged from days to months. Four patients were on anti-coagulants. Two had history of prior photodynamic therapy. There were five cases of PCV, of which three were macular in location. All three cases of AMD were macular. Intraoperative intravitreal ranibizumab injection was given in three cases and two had combined vitrectomy and cataract extraction. All cases reported improvement in visual acuity with four cases achieving 6/60 or better post operatively including two cases of extramacular PCV achieving 6/9 vision. Mean follow-up was 60 weeks. Postoperative complications included retinal tear and detachment in one case, reattached on reoperation. Six patients had a history of hypertension including one individual with stroke. Our small series indicates a predominance of Chinese individuals with BTB. Usage of anticoagulants and hypertension may be a predisposing factor. Better visual prognosis occurs with extramacular lesions which tend to be of PCV type.