Hypertension prevention and control in Malaysia: a review

Background: Hypertension is a major public health issue. It is the leading preventable risk factor for premature death and disability, mainly due to ischemic heart disease and stroke. In Malaysia, the age-adjusted prevalence of hypertension was 35.3% in 2015. Hypertension burden is expected to grow with the ageing population, urbanization, and unhealthy lifestyle. In this review, we aim to describe the current hypertension prevention and control program and its challenges in Malaysia, so that future strategies can be developed to further reduce hypertension prevalence. Methods: A narrative review was conducted in June 2020 using published and grey literature, policy and programme documents, guidelines, official statistics and technical reports that are related to hypertension prevention and control programme in Malaysia. Results: The National Strategic Plan for Non-communicable Diseases presented an overarching framework for primordial, primary, and secondary prevention of NCDs through a multi-faceted approach. The Salt Reduction Strategy has demonstrated a cost-effective, primary population-based prevention. The well-established health care system provided primary and secondary prevention through universal health coverage incorporating the Family Doctor Concept and guided by the Clinical Practice Guideline. Community-based programmes were launched to create a healthy environment that encourages and empowers communities to practice healthy behaviours. Conclusion: Moving the strategic plan forward will require substantial effort and significant capacity building through the whole of government and whole of society approaches. Furthermore, more implementation researches of innovative, cost-effective and sustainable programmes incorporating technologies, are needed to combat the country's emerging hypertension burden

Social cognitive predictors of physical activity among health workers

Background: In Malaysia, about 1 in every 3 adults are inactive. Health workers do not perform better in physical activity although they are seen as role models. Understanding of social cognitive predictors is important to motivate them to initiate and maintain regular physical activity. Objective: The study aimed to determine social cognitive predictors of physical activity among health workers. Methodology: An analytical cross sectional study was done among 310 health workers recruited by simple random sampling using validated self-administered questionnaires. Hierarchical multiple regression analysis was used to determine the predictors. Results: The respondents spent 141 minutes (IQR=182.7) in total physical activity per day. Leisure time physical activity contributed to 16.6% of the total physical activity, with the remaining were non-leisure time physical activities during occupational, household chores and transportation. Leisure time physical activity had significant positive correlation with goal setting (r=0.344, p<0.001), self-efficacy (r=0.283, p<0.001), friends support (r=0.305, p<0.001), outcome expectation (r=0.284, p<0.001), family support (r=0.193, p=0.001) and male gender (p=0.002), while had significant negative correlation with barriers (r=-0.256, p<0.001) and present of family history of medical illness (p=0.029). Hierarchical multiple regression analysis found that 23.0% (adjusted r2 = 0.218, p=0.029) of variance in leisure time physical activity was explained by social cognitive predictors with goal setting (r2=0.118, p< 0.001), barriers (r2=0.046, p<0.001), self-efficacy (r2=0.033, p<0.001), friend support (r2=0.021, p=0.004) and outcome expectation (r2=0.012, p=0.029). Gender added an additional of 1.8% of the variance (r2=0.018, p=0.007). Conclusion: Social cognitive predictors are useful to explain leisure time physical activity. The findings can be used in development of intervention to encourage behavioural change

Predictors of uncontrolled hypertension among patients receiving treatment from public primary care clinics in Pulau Pinang, Malaysia

Introduction: Hypertension treatment aims to reduce morbidity and mortality from cardiovascular and renal complications. In Malaysia, there is a high prevalence of uncontrolled hypertension among patients on treatment. This study aimed to identify the predictors of uncontrolled hypertension among patients receiving treatment from public primary care clinics in Pulau Pinang, Malaysia. Methods: An unmatched case-control study with 1:1 ratio was conducted among 334 hypertensive patients receiving treatment from selected public primary care clinics. Mean blood pressure measurements from the last two clinical visits were used to determine the hypertension status, and uncontrolled hypertension was defined as 140/90 mm Hg or higher. The cases were those with uncontrolled hypertension, while the controls were those with controlled hypertension. Participants were recruited by simple random sampling. Independent variables were sociodemographic factors, clinical and psychosocial factors, medication adherence, lifestyle modification, and clinical inertia. Data were collected using validated questionnaires and review of medical records. Multiple logistic regression analysis was performed by using IBM SPSS Statistics 25. Results: The mean age of respondents was 59 years (SD=11). Patients with medication non-adherence had 11.36 times higher odds of uncontrolled hypertension (aOR=11.36, 95% CI=6.59, 19.56, p <0.001). Clinical inertia increased 7.82 times the odds of uncontrolled hypertension (aOR=7.82, 95% CI=2.65, 23.09, p<0.001). Conclusion: Addressing medication adherence and clinical inertia are vital in reducing uncontrolled hypertension. The findings would help to prioritise interventions to improve the clinical management of hypertension and patient outcomes