By Arravinnath Subramanium

When was the last time you checked your blood pressure? At a clinic? At home?

Did you know that only five out of ten people in Malaysia are aware of their hypertensive status¹?

Does that statistic concern you? It definitely should! Hypertension is evolving into a condition that is becoming more common among Malaysians as days go by.

Hypertension is a systemic condition that can be defined as systolic blood pressure (SBP) of 140 mmHg or more, or diastolic blood pressure (DBP) of 90 mmHg or more².

To put it simply, hypertension is a condition in which blood vessels have unusually raised blood pressure persistently.

It is estimated that 1.13 billion people throughout the world are currently suffering from hypertension, of which two-third are living in low-income or middle-income countries.

Hence, the World Health Organization (WHO) has created a campaign for action for non-communicable diseases consisting of nine global voluntary targets. Among these targets, Target 6 aims to reduce the prevalence of hypertension by 25% by 2025 at the soonest.

In Malaysia, one in three people over the age of 18 are at the risk of developing hypertension while one in four men and one in five women have high blood pressure.

According to the National Health and Morbidity Survey (NHMS) by the Ministry of Health Malaysia in 2019, hypertension is one of the three major risk factors leading to heart disease, along with diabetes mellitus and high cholesterol.

Approximately 1.7 million Malaysians currently live with all these three risk factors, and this highlights the need for awareness and prompt treatment of hypertension among Malaysians³.

A population at risk

Who among Malaysians, and why is the Malaysian population at such a high risk?

Hypertension, through its complications, has been given the dubious reputation of being the leading risk factor that directly contributes to the death of 1.5 million Malaysians annually.

Generally, risk factors can be classified according to modifiable and non-modifiable risk factors.

Non-modifiable risk factors include a family history of hypertension, gender and ethnicity.

Modifiable risk factors such as smoking, obesity, lack of physical activity and the consumption of alcohol, contribute to the majority of hypertensive patients in Malaysia⁴.

Still wondering why hypertension is known as a silent killer?

Hypertension almost usually has little to no symptoms, putting Malaysians at risk of not knowing whether they even have the condition.

It is often too late when people are diagnosed with hypertension, as they have been hypertensive for a long time.

Hypertension mainly affects three major organs, namely the kidneys, heart, and brain. Failure of these organs can lead to death.

In renal damage, chronic renal failure that precedes end stage failure arises due to increased pressure on kidneys to produce ultrafiltrate, causing damage to nephrons and results in failure of the kidneys to maintain its function.

In cardiovascular disease, increased arterial blood pressure results in left ventricular hypertrophy (thickening of the left ventricle of the heart), causing a myriad of heart-related diseases including myocardial infarction, heart failure and arrhythmia.

In the brain, stroke or cerebrovascular accident (CVA) is the gravest consequence of hypertension.⁵ 

Hypertension also has adverse effects on vision and sexual function, especially in males, as high blood pressure damages artery walls, causing them to harden and narrow, thus leading to reduced blood flow to the penis..

Stopping hypertension in its tracks: our targets in eradicating hypertension

The statistics and the negative effects caused by hypertension are enough to concern Malaysians from all walks of life.

Malaysia, as of 2020, had carried out many different initiatives through various activities across all levels of the society.

Commonly, screening of hypertensive patients at hospitals, community health clinics and rural health clinics are usually cornerstones for the identification of hypertensive patients in the population.

Community-based screening and self-arranged health checks also assist in the recognition of people suffering from hypertension that would have otherwise gone undiagnosed and untreated, leading to increased mortality rates from complications of hypertension.

The involvement of Malaysians, in general, plays an important part in bringing down the statistics revolving around hypertension in the country.

Hypertensive patients are in fact the most powerful inciters of change by educating and empowering Malaysians to take control of their health and encourage them to check on their blood pressure often.

Medical students and medical student organizations such as Malaysian Medics International (MMI) are the voice of change on the impact of hypertension on Malaysians, especially in the future to come by framing policies and advocating for further screening procedures in our country.

Ongoing campaigns such as Kempen Sayangi Jantung Anda, kicked off by the Ministry of Health to combat heart disease, alongside Kempen Kesedaran Darah Tinggi and Kempen Cara Hidup Sihat, have aimed to promote awareness among the people regarding the risks of heart disease and hypertension.

Community leaders also play a large role in spreading information and proactively involving local authorities in the screening of people for the risk factors of hypertensive disease by setting up local health camps often, especially in conjunction with important dates such as World Heart Day on the 29 September every year.

We have seen many brilliant initiatives on the side of many different parties in the fight to reduce and ultimately end hypertension as a threat to Malaysian healthcare and the wellness of its people. Yet despite their ongoing efforts, many people still lack awareness regarding hypertension.

Good dietary practices such as reducing salt intake and reducing intake of fatty and oily foods, looking at alternative ways to handle stress at workplaces and encouraging physical activities and active participation of smokers in anti-smoking campaigns and clinics would definitely bring many positives in the drive to end hypertension in Malaysia.

Keep hypertension at bay, for a healthy day.

References:

¹ Man Jun Soo, Zhen Yee Chow, Siew Mooi Ching, Chun Han Tan, Kai Wei Lee, Navin Kumar Devaraj, Hani Syahida Salim, Vasudevan Ramachandran, Poh Ying Lim, Dhashani Sivaratnam, Fan Kee Hoo, Ai Theng Cheong, Yook Chin Chia; Prevalence, awareness and control of hypertension in Malaysia from 1980-2018: A systematic review and meta-analysis; Baishideng Publishing Group Inc; August 28, 2020.

² Matthew R Alexander, MD, PhD; Chief Editor: Eric H Yang, MD; What is the definition of hypertension (high blood pressure)? February 22, 2019.

³ National Health and Morbidity Survey 2019, Ministry of Health, Malaysia, 2019

⁴ Ooi Wei Lim and Chen Chen Yong; The Risk Factors for Undiagnosed and Known Hypertension among Malaysians; November 4; 2019.

⁵ Franz H. Messerli, Prof Bryan Williams, Prof Eberhard Ritz;Essential Hypertension; The Lancet Publications; August 18, 2007.