Role of coping mechanisms to psychosocial stress in early development of hypertension in young adults: a pilot study

Hypertension is a major risk factor for cardiovascular diseases, one of the leading causes of death worldwide. Prehypertension is a precursor of hypertension, with high prevalence in young adults. Psychosocial stress can be one of the modifiable risk factors for hypertension. The objective of the study is to assess the relationship between coping mechanism to psychosocial stress and early hypertension in young prehypertensive, mild essential hypertensive and normotensive subjects. A comparative cross-sectional pilot study was conducted in 36 young adults aged less than 45 years. The pulse rate, the blood pressure, and the body mass index of the respondents were recorded. Psychosocial stress was measured by plasma cortisolfollowing an acute mental stress test; and the level of stress and the coping strategies were assessed by using validated stress questionnaires. Approximately fourty four percent of subjects had normotension and 55.56% had prehypertension and mild hypertension.Prehypertension and mild hypertension were associated with high plasma cortisol level (p=0.032), and a high body mass index (p=0.004). Maladaptive coping strategy was found to be associated with high stress scores (p=0.019). The relationship between stress and cortisol was not significant, though a higher cortisol level was noted in the high blood pressure group. Higher cortisol levels and greater BMIs were associated with prehypertension and mild hypertension in young adults. These findings are useful for future research in this area, and the continuation of the study is important in the hope to yield a more significant picture

Emotional state of stress and coping strategies in newly-diagnosed hypertensive young adults; a descriptive study

Introduction: This study aims to evaluate the emotional state of stress and coping strategies in newly-diagnosed hypertension in young adults (YOH) according to the presence of emotional stress symptoms. Methods: In a cross-sectional study in Kuantan, Pahang, Malaysia, we evaluated one hundred and fifteen individuals aged between 18 to 45 years. Individuals who had never been diagnosed with hypertension and satisfied the systolic blood pressure reading of at least 140 mmHg and/or diastolic blood pressure of at least 90 mmHg were included. The stress state was assessed using the 21-items Depression Anxiety Stress Scale and the abbreviated Coping Orientation to Problems Experiences (Brief-COPE) Inventory. A stress domain score above 14 was considered abnormal. Results: There was no significant difference in age, systolic blood pressure, diastolic blood pressure, employment status, and education status between YOH with normal and abnormal stress levels. YOH with abnormal stress (n = 28, 24.4%) presented higher use of dysfunctional coping strategy which is behavioural disengagement (p = 0.016). However, they also used emotional-focused coping strategies including use of emotional support (p = 0.033), humor (p = 0.027) and religion coping (p = 0.007). Besides that, YOH with abnormal stress also displayed a higher planning score (p = 0.035) as a problem- oriented coping strategy. Conclusion: These findings suggested that YOH with higher stress tend to use less appropriate coping strategies. It is recommended to reinforce the adoption of problem-oriented strategies to deal with stress to avoid the detrimental effects of emotional coping on blood pressure levels

Blood pressure and 10-year cardiovascular risk profile of young hypertensives in Malaysia; a single centre study

: Introduction: Hypertension is being identified in younger population and the need for earlier diagnosis and intervention has resulted in the introduction of prehypertension in the classification of hypertension. Hypertension prevalence is at 33% and they contribute to a rising incidence of cardiovascular disease. The objective of the study is to assesses the 10-year cardiovascular risk profile of young hypertensieves from a single centre in Malaysia. Methodology: A total of 484 subjects were screened at a primary health care clinic in Kuantan, Malaysia. 57 subjected between the ages of 20 and 40 with systolic and diastolic blood pressure ranges of between 120-159 mmHg and 80-99 mmHg respectively were enrolled into a cross-sectional observational study. The cardiovascular risk-factor profile was assessed and the 10-year cardiovascular risk determined. Results: The mean age of the subjects were 32.74 ± 5.78 years. The mean systolic arterial pressures were 132.38 ± 10.34, 87.17 ± 7.55 and 102.06 ± 7.37 mmHg respectively. The mean fasting blood sugar 4.67 ± 0.75 mmol/L, total cholesterol 5.82 ± 0.96 mmol/L , low-density lipoprotein 3.73 ± 0.86 mmol/L, high-density lipoprotein 1.40 ± 0.37 mmol/L and body mass index 28.72 ± 5.24 kg/m2. The mean cardiovascular risk point was 4.07 ± 5.35 wherein 91.23% were in the low 10-year Coronary Artery Disease risk category ( Framingham CV Risk Score ) Conclusion: A great majority of young subjects within the prehypertension and stage 1 hypertension range had a low 10-year Coronary Artery Disease risk. They did however show higher than normal total cholesterol, low-density lipoprotein and body mass index levels

Relationship between coping mechanisms to psychosocial stress with blood pressure in young adults: a pilot study

Background: Hypertension is a major risk factor for cardiovascular diseases, one of the leading causes of death worldwide. Prehypertension is a precursor of hypertension, with high prevalence in young adults. Psychosocial stress can be one of the modifiable risk factors for hypertension. The objective of the study is to assess the relationship between coping mechanism to psychosocial stress and the blood pressure of young adults. Methods: A comparative crosssectional pilot study was conducted in 36 young adults aged less than 45 years. The pulse rate, blood pressure and body mass index of the respondents were recorded. Psychosocial stress was measured by plasma cortisol following an acute mental stress test; and the level of stress and the coping strategies to stress were assessed using validated Malay Version questionnaires: DASS- 21 and Brief R-COPE questionnaires. Results: Forty four percent of subjects had normotension and fifty six percent had above-normal blood pressure (prehypertension and mild hypertension). Subjects with above-normal blood pressure were associated with high plasma cortisol levels (p = 0.032), and high body mass indexes (BMI) (p = 0.004). Maladaptive coping strategy was found to be associated with high stress scores (p = 0.019). The relationship between stress and cortisol was not significant, though a higher cortisol level was noted in the high blood pressure group. Conclusion: In conclusion, higher cortisol levels and greater BMIs were associated with above-normal blood pressure in young adults. These findings are useful for future research in this area, and the continuation of this study will hopefully yield a more significant relationship

Copy number variation of CNVesv27061 analysis among young adults with high blood pressure using optimized droplet digital polymerase chain reaction (ddPCR) method

Several reports and databases on genomic variants have associated variation in DNA sequences (≥ 1kb), or copy number variation (CNV), with susceptibility to common diseases. However, very few reports are found on hypertension and no study has been reported on CNV in prehypertensive and hypertensive young adult Malaysians. In this comparative cross-sectional study, 133 young adults were recruited, comprising of normotensive (45 subjects), prehypertensive (40 subjects) and mild hypertensive (48 subjects) subjects. DNA for CNV determination was extracted from 3 ml of blood samples collected. CNV esv27061 was analysed using optimized droplet digital polymerase chain reaction (ddPCR) method which has enhanced sensitivity and precision. Frequency distribution patterns of CNV among mild hypertensives showed highest peak copy-number-gain (number of copies more than 2) particularly in copy numbers 3 and 5. The prehypertensive subjects exhibited marked increase in copy number 5 when compared with normotensives. All the subjects in this study showed low frequency distribution pattern for copy numbers 2, 6 and 7. This discovery emphasizes the importance of frequency patterns in determining CNV status of prehypertensive and mild hypertensive subjects. Optimization method in this study showed that the detection of CNV esv27061 is possible in our sample population

Prehypertensive state, mild hypertension, metabolic syndrome and cardiovascular risk factors among young adults in rural Malaysia

Introduction: Prehypertension precedes overt hypertension and has been acknowledged by many guidelines. Hypertension is an important risk factor for cardiovascular disease in Malaysia. Hypertension prevalence is at 42.6% and population-based control is poor at 26.8%. The objective of the study is to ascertain the cardiovascular risk profile of prehypertensive and mildly hypertensive young adults against age-matched controls in rural Malaysia. Methods: 484(four hundred and eighty four) subjects attending primary care clinic were screened. 91 (Ninety one) young adults with pre/mild hypertension and normotensive, age-matched controls were enrolled. The blood pressure and biochemical profiles for both groups were assessed and compared. Results: Fifty-four subjects and 37 controls were enrolled. Amongst subjects, 46.3% had prehypertension and 53.7% had mild hypertension. Mean values compared to age- matched controls for MAP were 102.68 ± 7.48 vs 83.25 ± 6.08 mmHg (p< 0.001), LDL 3.75 ± 0.95 vs 3.32 ± 0.93 mmol/L (p=0.03), FBG 4.65 ± 0.54 vs 4.33 ± 0.42 mmol/L (p=0.03), BMI 28.81 ± 5.16 vs 24.12 ± 4.91 (p< 0.001). The mean BP was significantly associated with BMI, FBG, triglycerides, HDL and the TC/HDL ratio. Conclusions: Greater BMI, FBG, HDL, triglyceride levels and TC/HDL ratio characterised the young adults with pre/mild hypertension. The data suggests that hypertension in young adults is secondary to metabolic syndrome

Systematic review on role of miRNAs in acute Myocardial Infarction of young adults

Acute myocardial infarction (AMI) is the leading cause of death worldwide. In Malaysia, people are getting AMI at younger age compared to well-developed countries. The role of microRNA (miRNA) in pathogenesis of AMI is not well elucidated and its involvement in young population has not been studied. The systematic review performedusing available electronic databases and also previous reviews. The databases were broad search and began with the generic terms to identify search terms that were relevant. Databases including PubMed, Science Direct and Medline were searched between January 2010 and December 2020 for this systematic review. A total of 97 articles found. Only 1 article showed that the research was done in young AMI population. 13 miRNAs were found to be upregulated and 16 downregulated in young acute coronary syndrome (ACS) patient, which included both ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI). miRNA 183-5p was significantly upregulated in ACS patients with NSTEMI whereas miRNA 134-5p, miRNA 15a-5p and let 7i-5p weresignificantly downregulated in patients with STEMI compared to healthy control. Plasma miRNA 183-5p, miRNA 134-5p, miRNA 15a-5p and let 7i-5p were dysregulated in STEMI and NSTEMI where they can potentially be used to discriminate the two ACS forms in future study

Evaluation of anti-hypertensive drug utilisation and cost in Hospital Tengku Ampuan Afzan, Kuantan

Introduction: Hypertension is one of the most important risk factors for cardiovascular disease in Malaysia. The prevalence of hypertension nearly doubled over a ten-year period (1986 – 1996). This has resulted in a significant rise in its attendant cost. We aim to review the institutional anti-hypertensive use, the cost incurred and the implications on management in our local setting. Materials and Methods: A retrospective review of the annual cost (2006) of anti-hypertensive medications was undertaken at the Department of Pharmacy, Hospital Tengku Ampuan Afzan, a 600-bed major regional hospital on the east-coast of Malaysia. The total number of prescriptions given out and the total cost per drug is then factored to give the annual cost per drug per person in a percentage of the total annual expenditure. Results: The majority of patients were on either 2 (46.5%) or 3 (25.9%) anti-hypertensives. The most frequently prescribed medications were ACE Inhibitors (33.45%), Calcium channel blockers (29.63%), diuretics (16.67%) and β-blockers (13.64%). In terms of cost however, the Calcium channel blockers constituted the greatest percentage of the annual anti-hypertensive budget (63.67%) compared to ACE Inhibitors at just 20.04% of the annual expenditure. The least costly group of drugs is the diuretic making up 16.67% of the total annual prescriptions but only constituting 1.23% of the annual cost. Conclusion: The majority of patients were on ACE Inhibitors and/or Calcium channel blockers. This has huge monetary implications as they represent a large proportion of the annual antihypertensive allocation. There may be a need to reverse the trend in the developing world due to cost restrictions

The role of miRNAs in acute Myocardial Infarction of young adults

Acute myocardial infarction (AMI) is the leading cause of death worldwide. In Malaysia, people are getting AMI at younger age compared to well-developed countries. The role of microRNA (miRNA) in pathogenesis of AMI is not well elucidated and its involvement in young population has not been studied. miRNAs possibly affect the atherogenesis, a precursor for AMI by affecting the genes that regulate endothelial stability, atherosclerotic plaque destabilization, fibrogenesis and heart remodelling post infarction. Understanding the pathogenesis of AMI in this young population is important in providing accurate diagnosis and prompt management of the disease. The aim of our study is to investigate how miRNAs contribute to the pathogenesis of AMI by profiling specific miRNAs that are dysregulated following an AMI in young group and to determine whether these miRNAs lead to the dysregulation of their target mRNA. Blood sample will be taken from the control, young and mature AMI groups and divided into 2 aliquots for the miRNA profiling analysis and mRNA analysis. The gene expressions will be analysed using the Bio-Rad CFX96 software. The significance of miRNA and mRNA expressions will be assessed using appropriate statistical analysis. The discovery of miRNAs involved in the AMI pathogenesis in this study could lead to potential usage as novel biomarkers for detection of early cardiac injury, prognosis and therapeutic intervention

Systematic review on role of miRNAs In AMI of young adults

Acute myocardial infarction (AMI) is the leading cause of death worldwide. In Malaysia, people are getting AMI at younger age compared to well-developed countries. The role of microRNA (miRNA) in pathogenesis of AMI is not well elucidated and its involvement in young population has not been studied. The systematic review performed using available electronic databases and also previous reviews. The databases were broad search and began with the generic terms to identify search terms that were relevant. Databases including PubMed, Science Direct and Medline were searched between January 2010 and December 2020 for this systematic review. A total of 97 articles found. Only 1 article showed that the research was done in young AMI population. 13 miRNAs were found to be upregulated and 16 downregulated in young acute coronary syndrome (ACS) patient, which included both ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI). miRNA 183-5p was significantly upregulated in ACS patients with NSTEMI whereas miRNA 134-5p, miRNA 15a-5p and let 7i-5p were significantly downregulated in patients with STEMI compared to healthy control. Plasma miRNA 183-5p, miRNA 134-5p, miRNA 15a-5p and let 7i-5p were dysregulated in STEMI and NSTEMI where they can potentially be used to discriminate the two ACS forms in future study