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 Table of Contents  
ORIGINAL ARTICLE
Year : 2011  |  Volume : 3  |  Issue : 12  |  Page : 540-543

Prevalence, awareness and control of hypertension in estate workers in Malaysia


1 Faculty of Medicine, University Technology MARA, Malaysia
2 Faculty of Medicine, Mahsa University College, Malaysia
3 Monash University, Malaysia

Date of Web Publication19-Dec-2011

Correspondence Address:
Chandramouli Annamalai
Senior lecturer, Faculty of Medicine, University Technology MARA
Malaysia
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Source of Support: None, Conflict of Interest: None


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  Abstract 

Background : Hypertension continues to be a major causative factor contributing to cardiovascular, cerebrovascular and renal morbidity and mortality. Aim : The objective of this study was to assess the prevalence, awareness and control of hypertension in the estate population in Johor, Malaysia. Patients and Methods : A mercury sphygmomanometer was used to record systolic and diastolic blood pressures. Cross sectional population survey was carried out in the study. Results: The overall prevalence of hypertension in 903 subjects studied was 26.91% (243). A higher prevalence 27.65 % (133) was found in males against 26.07% (110) in females. Awareness of the disease was present in only 39% (96) of which 86.45% (83) received treatment. Among those who received treatment, control of hypertension was present in 15.66% (13). Conclusion : The prevalence of hypertension among the estate population is lower than that of the general population of Malaysia, which can be attributed to their regular physical activity but the awareness, treatment, control and follow-up of patients is disappointingly low.

Keywords: Estate workers, hypertension, prevalence, physical activity


How to cite this article:
Annamalai C, Govindaraja C, Chandramouli C. Prevalence, awareness and control of hypertension in estate workers in Malaysia. North Am J Med Sci 2011;3:540-3

How to cite this URL:
Annamalai C, Govindaraja C, Chandramouli C. Prevalence, awareness and control of hypertension in estate workers in Malaysia. North Am J Med Sci [serial online] 2011 [cited 2019 Dec 9];3:540-3. Available from: http://www.najms.org/text.asp?2011/3/12/540/90868


  Introduction Top


Hypertension continues to be a blight on the community and is a major etiological factor contributing to the cardiovascular, cerebrovascular and renal morbidity and mortality. With obesity spreading as a global epidemic it is a major challenge to the health professionals to control hypertension in the population. According to a survey on the prevalence of hypertension in the Asia Pacific region, it was found to be in the range of 5-47% in men and 7-38% in women. The third national survey on health and morbidity in Malaysia came up with 32.9% of the population to be hypertensive [1].

It is a well known that exercise reduces blood pressure [2], and is advocated as one of the non-pharmacological methods of controlling hypertension. Research has shown an inverse relationship between physical exercise and blood pressure [3],[4].

The aim of our study is to estimate the prevalence of hypertension, to find out the awareness and control of the disease in people with moderate to severe physical activity. Hence the study group was the estate workers whose work entails manual labor.


  Patients and Methods Top


The study is a population based, cross-sectional study aimed at the estate population in the state of Johor in peninsular Malaysia. The study was conducted on the pay day of the workers so as to screen the maximum number of workers. The nature of the study was explained to them and those who consented were included in it. Nine hundred and three persons participated in the screening test. Blood pressure was measured after the subjects rested for at least fifteen to twenty minutes using a sphygmomanometer by two medical doctors and the data recorded by a trained student. According to the definition made by American Heart Association, hypertension was defined as a systolic blood pressure of > 140 mm of Hg and diastolic blood pressure of >90 mm Hg. The study was conducted over three months in the different estates and aimed to find out 1) the prevalence of hypertension among the estate workers; 2) the family history of hypertension; 3) the awareness of the disease; and 4) the percentage of patients on treatment.

Data on all the subjects examined was given to the health attendants at the estate clinics. Those whose hypertension was under control were asked to continue the same treatment. Newly diagnosed patients and those not controlled by treatment or not complying with treatment were advised to consult the nearest government hospitals.


  Results Top


The total number of participants in the screening program was nine hundred and three out of which four hundred and eighty one (53.27 %) were males and four hundred and twenty two (46.73 %) were females [Figure 1]. The mean systolic and diastolic blood pressure and standard deviation in males and females are shown in [Table 1] males and 131 (31.04 %) were females. A total of 243 (26.91%) subjects were found to be hypertensive of which 133 (27.65%) were males and 110 (26.91 %) were females. Statistical analysis using Pearson chi2 test was done and the difference between blood pressure values of males and females was found to be statistically significant (P = 0.006) [Table 2].
Figure 1: Percentage of male and female respondents in Johor estates

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Table 1: Description of blood pressure among respondents

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Table 2: Comparison of blood pressure level for male vs. female

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A total of 340 (37.65 %) subjects were found to be normotensive. Of the 481 males screened, 159 (33.06 %) were normotensive. Of the 422 females screened, 181 (42.89 %) were normotensive. Overall 320 subjects were found to be prehypertensive of which 189 (39.29 %) were Pearson's correlation coefficient showed a significant correlation between the systolic and diastolic blood pressure to be os = 0.82 with a P-value < 0.001 [Figure 2].
Figure 2: Correlation coefficient between Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP)

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Family history of hypertension was present in two hundred and fifty five subjects and awareness of the disease was present in ninety six individuals and eighty three patients were on treatment. Of the 83 patients on treatment, effective control of hypertension was found only in 13 of them.


  Discussion Top


During the past half a century, hypertension has been identified as a major risk factor in the development of cardiovascular disease, morbidity and mortality [5]. Researchers have also observed that South Asians are predisposed to hypertension and coronary artery diseases possibly due to insulin resistance [6]. In Malaysia hypertension is found to independently affect cardiovascular disease adversely in the past five decades. It has been estimated that there are one billion individuals with hypertension worldwide and 4.8 million in Malaysia alone. A National Health and Morbidity survey done in 2004 by a group of researchers has found the prevalence of hypertension among adults thirty years and above to be 40.5% [1].

In this study, the overall hypertensive subjects were 243 reflecting 26.91% of the screened estate population. The prevalence of hypertension observed in this study is significantly lower than that of the national survey done in 2004 in the general population. This is possibly due to the fact that the study subjects were manual laborers and the nature of their occupation engaged them in regular physical activity. Epidemiological data from various studies have shown a strong correlation between blood pressure and physical activity [4],[7],[8]. Research has proved that reduction in blood pressure occurs with exercise or increased physical activity [9],[10],[11] and improving exercise capacity and quality of life [12]. The antihypertensive effects of exercise has been found to reduce the need for antihypertensive drugs to a large extent [13].

The prevalence of hypertension was found to be higher in males in this survey(27.65%) than that of (26.07%) in females. A significant difference in the prevalence between males and females was found using Pearson's chi 2 test (P = 0.006).

Coming to the family history, 255(28.25% individuals revealed a family history of hypertension in one or both parents. Association of family history of hypertension and its prevalence have been studied by other researchers and has been proved that the incidence of hypertension is twice as much as seen in those without family history [14]. Awareness of hypertension in our study was observed only in 96(39.50%) individuals but higher than that of the National Health and Morbidity Survey (NHMS) of Malaysia in 2004 where the awareness was 34.6% [1].

243 (26.91%) were found to be hypertensive. 96 (39.5%) individuals had awareness of the disease and 83 (34.16%) received treatment whereas only 13 (15.66%) of them had good control of hypertension. The newly diagnosed patients were 147 (60.49%). Those patients on treatment had poor compliance as they did not carry the drugs to the work spot. Poor compliance to treatment has been addressed in many studies as to how to improve adherence to treatment. Prescribing pattern in primary health care clinics not in accordance with the guidelines is one of the reasons for non - adherence to treatment Simplifying the dosage regimens by reducing the number of doses and motivating the patients has largely increased patient compliance to treatment [15],[16],[17]. Researchers have discussed the so-called "therapeutic inertia," i.e., "the failure of health professionals to initiate or intensify a therapy when this is indicated" [16]. Reinforcing the interventions by pharmacists at the hospital clinics by educating and counseling the patients has largely shown to have a better outcome in the reduction of blood pressure [18].

A significant number of the population did not seek treatment or have routine medical check-up which could be the reason for the tardy diagnosis. Most of them were diagnosed only when they were symptomatic, had complications of hypertension like stroke or myocardial infarction or when they attended the clinic for some other illness. A nationwide telephone survey conducted in Malaysia to test the patients' knowledge and attitude to treatment and control of hypertension has revealed that patients gave up treatment owing to lack of motivation and concern over the side effects [19]. Improved communication with patients, patients' education, assessing side effects like erectile dysfunction arising out of antihypertensive medications, diligently sharing the decision in choosing the alternatives will certainly go a long way in attaining the goal. The early diagnosis of hypertension and better control of the same can be achieved with the co-operation of the health care professionals and workers taking a greater responsibility in educating the patients, adhering to the guidelines in prescribing the drugs, monitoring the adverse effects and helping patients choose alternatives [20].


  Conclusion Top


Prevalence of hypertension has been found to be lower in the estate population. This could be due to their regular physical activity playing a pivotal role in bringing down the blood pressure. Physical activity offers protection in cardiovascular diseases and physical inactivity is a risk factor for cardiovascular disease by increasing the incidence of obesity, diabetes and hypertension. In rural areas, early diagnosis, close follow-up and referral of the patients by health assistants will have a significant impact on the reduction and control of hypertension.


  Acknowledgement Top


The authors are thankful to all the estate managers, health assistants, and estate workers of Johor state, Malaysia for their participation in the survey. The authors also thank Professor Dr. Than Winn and Dr. Aung Ko Ko Min, Mahsa University College for their input in statistical analysis.

 
  References Top

1.Rampal L, Rampal S, Azhar MZ et al. Prevalence, awareness, treatment and control of hypertension in Malaysia: A national study of 16,440 subjects. Public Health 2008; 122: 11-18.  Back to cited text no. 1
    
2.Hagberg JM, Park JJ, Brown MD. The role of exercise training in the treatment of hypertension : an update. Sports Med 2000; 30 (3): 193-206.  Back to cited text no. 2
    
3.Miall WE, Kass EH, Ling J, et al. Factors influencing arterial blood pressure in the general populatin in Jamaica. Bri Med J 1962; 25: 497-506.  Back to cited text no. 3
    
4.Montoye HJ, Metzner HL, Keller JL, et al. Habitual physical activity and blood pressure. Med Sci Sports Exerc 1972; 4:175-181.  Back to cited text no. 4
    
5.Sytkoski PA, D'Agostino RB, Belanger AJ, et al. Secular trends in long term sustained hypertension, long term treatment and cardiovascular mortality. Framingham heart study 1950-1990. Circulation 1996; 93: 697-703.  Back to cited text no. 5
    
6.Singh RB, Rastogi SS, Rastogi V, et al. Blood pressure trends, plasma insulin and risk factors in the rural and urban elderly population of north India. Coro Art Dis 1997; 8: 463-468.  Back to cited text no. 6
    
7.Taylor HL. Occupational factors in the study of coronary heart disease and physical activity. Can Med Assoc J 1967; 96: 825-831.  Back to cited text no. 7
[PUBMED]  [FULLTEXT]  
8.Powell KE, Thompson PD, Caspersen CJ, et al. Physical activity and the incidence of coronary heart disease. Annu Rev Public Health 1987; 8: 253-287.  Back to cited text no. 8
[PUBMED]  [FULLTEXT]  
9.Whelton SP, Chin A, Xin X, et al. Effect of aerobic exercise on blood pressure: a meta analysis of randomised controlled trials. Ann Intern Med 2002; 136(7): 493-503.  Back to cited text no. 9
    
10.Fagard RH. The role of exercise in blood pressure control: supportive evidence. J Hyperten 1995; 13(11): 1223-1355.  Back to cited text no. 10
    
11.Hinderliter A, Sherwood A, Gullette EC, et al. Reduction of left ventricular hypertrophy after exercise and weight loss in overweight patients with mild hypertension. Arch Intern Med 2002; 162: 1333-1339.  Back to cited text no. 11
[PUBMED]  [FULLTEXT]  
12.Tsai JC, Yang HY, Wang WH, et al. The beneficial effects of regular endurance exercise training on blood pressure and quality of life in patients with hypertension. Clin Exp Hyperten 2004; 26: 255-265.  Back to cited text no. 12
    
13.Kokkinos PF, Puneet N, Colleran JA, et al. Effects of Regular exercise on Blood Pressure and Left Ventricular Hypertrophy in African- American Men with Severe Hypertension. N Engl J Med 1995; 333: 1462-1467  Back to cited text no. 13
    
14.Stamler R, Stamler J, Riedlinger WA, et al. Family (Parental) History and Prevalence of Hypertension. JAMA 1979; 241(1): 43-46.  Back to cited text no. 14
    
15.Ramli AS, Miskan M, Ng KK, et al. Prescribing of antihypertensive agents in public primary care clinics - is it in accordance with current evidence? Malaysian Family Physician 2010; 5( 1): 36-40.  Back to cited text no. 15
    
16.Phillips LS, Branch WT, Cook CB, et al. Clinical inertia. Ann Intern Med. 2001; 135 (9): 825-834.  Back to cited text no. 16
    
17.Shroeder K, Fahey T, Ebrahim S. How can we improve adherence to blood pressure lowering medication in ambulatory care? Systematic review of randomised controlled trials. Arch Intern Med 2004; 164(7): 722-32.  Back to cited text no. 17
    
18.Margado M, Rolo S, Castelo-Branco, M. Pharmacist intervention program to enhance hypertension control: a randomised controlled trial. Int J Clin Pharm 2011; 33: 132-140.  Back to cited text no. 18
    
19.Khoo KL, Liew YM, Tan H, et al. Patients' knowledge and attitude towards treatment and control of hypertension: a nation-wide telephone survey conducted in Malaysia. Med J Malaysia 1999; 54(1): 37-46.  Back to cited text no. 19
    
20.Harmon G, Lefante J, Wood KM. Overcoming barriers: the role of providers in improving patient adherence to antihypertensive medications. Curr Opin Cardiol 2006; 21(4): 310-315.  Back to cited text no. 20
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2]


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Abstract
Introduction
Patients and Methods
Results
Discussion
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