The heart pumps blood to the body through the blood vessels, which resists the blood flow.
Blood pressure is recorded with two measurements – systolic and diastolic, in millimetres mercury (mmHg). The former is the force of the heart and the latter is the resistance in the blood vessels.
Generally, high blood pressure is 140/90 mmHg or more and low blood pressure is 90/60 mmHg or lower.
A blood pressure between 120/70 and 140/90 mmHg means that there is risk of increased blood pressure.
The risks of high blood pressure (hypertension) are heart disease, attacks and failure; stroke; peripheral arterial disease; kidney disease; aortic aneurysms; and vascular dementia.
The relationship between blood pressure and cardiovascular events is continuous, consistent and independent of other risk factors. The higher the blood pressure, the greater the risks.
Additional risk factors like diabetes, dyslipidaemia (abnormal amounts of fats) or smoking compound the risks.
The likelihood of hypertension increases with increasing age, overweight or obesity, inactivity, consumption of excess salt and/or caffeine products, smoking, family member with hypertension, and long-term sleep deprivation.
National Health and Morbidity Survey 2015
The overall prevalence of hypertension (known and undiagnosed) among adults of 18 years and above in the National Health and Morbidity Survey (NHMS) 2015 was 30.3%.
The prevalence increased with age, from 6.7% in the 18-19 years age group to 75.4% in the 70-74 years age group. (Source: Institute for Public Health 2015. NHMS 2015. Vol. II: Non-Communicable Diseases, Risk Factors & Other Health Problems; 2015)
The prevalence in rural areas was 33.5%, compared to 29.3% in urban areas. The prevalence of undiagnosed hypertension was 17.2%.
Other findings from NHMS 2015 include:
• The overall prevalence in females was 29.7% and 30.8% in males;
• Other bumiputras had a prevalence of 33.4%, followed by the Indians at 32.4%, Malays at 31.1% and Chinese at 30.8%.
Of the known hypertensives, the findings included:
• The prevalence of known hypertension was 13.1%, increasing from 0.7% in the 18-19 years age group, reaching a peak of 50.4% in the 70-74 years age group;
• The prevalence in females was 14.0% and 12.2% in males;
• Indians had a prevalence of 17.0%, followed by other bumiputras at 15.7%, Chinese at 15.2%, and Malays at 12.5%;
• A total of 81.2% claimed to be on oral anti-hypertensive drugs within the past two weeks; 85.9% had received specific diet advice from healthcare personnel; 69.8% claimed to have been advised by healthcare personnel to lose weight; and 80.4% had been advised to be more physically active or start exercising;
• With regards to their usual place of treatment, more than half of them sought treatment at Health Ministry (MOH) health clinics (58.3%), followed by private clinics (19.0%), MOH hospitals (17.7%) and private hospitals (2.7%);
• About 2.0% self-medicated by purchasing medications directly from pharmacies;
• Some 0.3% took traditional and complementary medicine.
Of the undiagnosed hypertensives, the findings included:
• The prevalence of undiagnosed hypertension was 17.2%, increasing from 6.0% in the 18-19 years age group to a peak of 28.7% in the 65-69 years age group;
• The prevalence was 20.7% in rural areas and 16.1% in urban areas;
• The prevalence in males was 18.6% and 15.6% in females;
• Malays had a prevalence of 18.6%, followed by other bumiputras at 17.6%, Chinese at 15.6% and Indians at 15.4%.
Too many undiagnosed
There were two persons diagnosed with hypertension compared to three with undiagnosed hypertension – a ratio of 2:3 in NHMS 2015, which was similar to NHMS 2011.
A team from the MOH and the Universities of Malaya and Melbourne studied the data on hypertension in NHMS 2011.
They found that the age-standardised prevalence of hypertension was estimated to be 33.9%. Only 39.0% of adults with hypertension had been diagnosed by a medical practitioner, 35.7% had been on treatment, and 9.6% had blood pressure controlled under treatment.
The diagnosis, treatment and controlled treatment coverage were higher for older persons compared to younger persons.
There were no differences in the diagnosis and treatment coverage between urban and rural areas, and between ethnic groups. However, controlled treatment coverage was higher among Chinese and those living in urban areas.
Ischaemic heart disease, cerebrovascular disease and chronic kidney disease were the first, second and ninth causes of deaths in 2016, with an increase of 39.6%, 23.8% and 34.3% respectively since 2005.
Ischaemic heart disease and cerebrovascular disease were the top two causes of death and disability combined in 2016.
Hypertension ranked as the second most significant risk factor of death and disability combined in 2016, with a 47.2% increase since 2005. It contributed to 42.2% of deaths.
These data are not surprising when the numbers of undiagnosed and inadequately controlled hypertensives are so high.
The magnitude of the hypertension problem needs particular attention. Screening in primary care settings and frequent health promotion to enhance increased community awareness and commitment to healthy living and care have often been emphasised.
The MOH’s objective is to reduce the prevalence of hypertension from 32.2% to 26.0% (Source: National Strategic Plan for Non-Communicable Disease 2016-2020, page 9). However, the details of the roadmap are unclear.