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Prevalence, Awareness, Treatment and Control of Hypertension in the Malaysian Population: findings from the National Health and Morbidity Survey 2006–2015

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Prevalence, Awareness, Treatment and Control of Hypertension in the Malaysian Population: findings from the National Health and Morbidity Survey 2006–2015 Journal of Human Hypertension https://doi.org/10.1038/s41371-018-0082-x ARTICLE Prevalence, Awareness, Treatment and Control of hypertension in the Malaysian population: findings from the National Health and Morbidity Survey 2006–2015 1 1 2 3 1 Nur Liana Ab Majid ● Mohd Azahadi Omar ● Yi Yi Khoo ● Balkish Mahadir Naidu ● Jane Ling Miaw Yn ● 1 1 1 1 Wan Shakira Rodzlan Hasani ● Halizah Mat Rifin ● Hamizatul Akmal Abd Hamid ● Tania Gayle Robert Lourdes ● Muhammad Fadhli Mohd Yusoff1 Received: 25 March 2018 / Revised: 21 May 2018 / Accepted: 29 May 2018 © The Author(s) 2018. This article is published with open access Abstract Hypertension is strongly associated with chronic diseases such as myocardial infarction, stroke, heart failure, and renal failure. The objective of this study is to determine the trend of prevalence, awareness, treatment, and control of hypertension among Malaysian population since 2006 to 2015. The study used the data from National Health and Morbidity Survey (NHMS) 2006, 2011, and 2015. It was a cross-sectional with two-stage stratified random sampling throughout Malaysia for eligible respondents 1234567890();,: 1234567890();,: 18 years old and above. Respondents were interviewed face to face and blood pressure was recorded as the average reading from two electronic pressure monitoring measurements. Data was analyzed using the Complex sample module in SPSS Version 20. The prevalence of hypertension in Malaysia was 34.6% (95% CI: 33.9, 35.3) in 2006, 33.6% (95% CI: 32.6, 34.6) in 2011 and 35.3% (95% CI: 34.5, 36.3) in 2015. Awareness of hypertension in 2006, 2011, and 2015 was 35.6% (95% CI: 34.6, 36.6), 40.7% (95% CI: 39.3, 42.1), and 37.5% (95% CI: 36.1, 38.9) respectively. The trend of receiving treatment from 2006 to 2015 was 78.9% (95% CI: 77.5, 80.2) to 83.2% (95% CI: 81.3, 84.8). The control of hypertension increased significantly from 27.5% (95% CI: 25.9, 29.2) in 2006 to 37.4% (95% CI: 35.3, 39.5) in 2015. Despite higher proportions receiving treatment over time, the control of hypertension remained below 40% since NHMS 2006 until 2015. The strategies to further reduce the prevalence and increase awareness of hypertension should be enhanced particularly among the targeted age group to ensure early detection, treatment, and control thus preventing from long-term complications. Introduction the mortality is due to CVD and, furthermore, one of the major cause of premature mortality [6, 7]. Hypertension is a global public health issue [1] strongly Like many other countries, CVD and hypertension have associated with chronic diseases such as myocardial increased in Malaysia over time. Part of this is due to infarction, stroke, heart failure, and renal failure. It is esti- improved screening and diagnosis as medical services mated that 6% of deaths worldwide are due to high blood improve in the country. Early screening and detection of pressure (BP) [2] but it is a preventable disease and a hypertension can reduce its complications, hence, its asso- modifiable risk factor [3, 4]. Cardiovascular disease (CVD) ciated mortality rate. This will reduce the disease burden is the most common cause of death in developed countries socially and economically. and a rapidly evolving cause of mortality and morbidity in Community surveillance has been the most common economically developing countries [5]. In Malaysia, 36% of approach to evaluating the success of efforts to treat and control high BP. Although surveys are not a perfect eva- luation tool, they are necessary to obtain information about * Nur Liana Ab Majid persons who are, hitherto, unaware that they have hyper- [email protected] tension or those who are aware but not compliant with medical advice [4]. 1 Institute for Public Health, Bangsar, Kuala Lumpur, Malaysia In this regard, a nationwide community survey, the 2 University of Malaya, Kuala Lumpur, Malaysia National Health and Morbidity Survey (NHMS), has been 3 Department of Statistic Malaysia, Kuala Lumpur, Malaysia undertaken periodically in Malaysia since 1986 to assess the NL Ab Majid et al. Nation’s health. These nationwide surveys have revealed a ● Seated position, back supported, arm supported rising prevalence of hypertension in the country, similar to ● Seated with legs uncrossed, not talking, and relaxed many other developing countries. In NHMS 1996, one-third ● The correct cuff bladder placed at heart level with the of the population aged 30 years and above was diagnosed correct cuff size. with hypertension. The survey also found very low aware- ness, treatment, and control among hypertensive respondents. Blood pressure results were obtained and immediately Recently, the data from NHMS 2015 were made available, recorded in the questionnaire. Respondents were informed thus, we were able to compile the results for hypertension of the results and, if found to be hypertensive (systolic from 2006 until 2015 to look at the trend of hypertension in blood pressure ≥140 mmHg or a diastolic blood pressure Malaysia. This trend will provide us with information ≥90 mmHg), they were referred to the nearest health facility regarding the change in hypertension prevalence over 10 clinic for further evaluation and management. years. Analysing the change will provide evidence on the Height was measured in centimeter using SECA Stadi- direction of our healthcare services for the population. ometer 213 and weight was measured in kilogram using Tanita Personal Scale HD 319. Body mass index was calcu- lated as weight in kilograms divided by height in meters Methodology squared and grouped into three categories according to WHO guidelines: <25.0 kg/m2 as underweight to normal weight, All National Health and Morbidity Surveys (NHMS) were 25.0 to 29.9 kg/m2 as overweight and ≥30.0 kg/m2 as obesity. conducted by the Institute for Public Health under the Ministry of Health Malaysia. The Survey was conducted Definitions once every 10 years from 1986 to 2006, and thereafter, at 4- year intervals. In this study, we analyzed the data from Hypertension: respondents were classified as having NHMS 2006, 2011 and 2015. The study was approved by hypertension if their blood pressure was ≥140 mmHg sys- Medical Review & Ethics Committee within Ministry of tolic or ≥90 mmHg diastolic or told to have hypertension by Health. All respondents provided written informed consent. medical personnel previously. This protocol is in accor- The sampling design was cross-sectional with two-stage dance with the Seventh Annual Report of the Joint National stratified random selection throughout Malaysia provided Committee [10]. by Department of Statistics Malaysia. The first stage sam- Awareness of hypertension: awareness (yes/no) was pling unit was the Enumeration Block (EB) and, within defined as having ever been told to have hypertension by a each sampled Enumeration Block, the Living Quarters (LQ) medical doctor or paramedic among all hypertensive were selected as the second stage. All households and eli- respondents. gible persons within each selected LQ were included in the Current treatment for hypertension: respondents taking study. Eligibility criteria depended on individual surveys or antihypertensive medication within 2 weeks at the time of sub-survey. For the hypertension data, eligible respondents interview. were 18 years and above. The estimated sample size at the Control of hypertension: controlled hypertension was national level was based on the stratification of respondents defined as having a desirable blood pressure level (<140/ by states and by urban/rural. <90 mmHg). Background data were obtained by face to face interview with each respondent after obtaining written informed Statistical analysis consent. Blood pressure was recorded as the average read- ing from two electronic pressure monitoring measurements. Data from the NHMS 2006, 2011, and 2015 were analyzed The blood pressure measurement, weight and height were using the Complex sample module in SPSS Version 20 carried out by trained nurses. [11]. Sampling errors were estimated using the primary All household members age 18 years and above were sampling units and strata provided in the data set. Sampling examined for their blood pressure. Two readings of systolic weights were used to adjust for non-response bias. As the and diastolic pressure within 15 min apart were taken using sampling was two-stages stratified in design, the analysis Omron Digital Automatic Blood Pressure Monitor Model was done accordingly to ensure sample weights and design HEM-907 which was already validated and calibrated [8]. effect was accounted for. Age adjusted values were stan- Blood pressure was taken using the standard procedure as dardized to the age distribution of the Malaysian population below [9]: from the 2015 Census. The overall prevalence, as well as the awareness, treatment, and control rates were determined. ● Without smoking, meal, caffeine intake, or physical A comparison of findings is possible as all NHMS surveys exercise for at least 15 min used a similar methodology. Prevalence, Awareness, Treatment and Control of hypertension in the Malaysian population: findings from. Table 1 Sociodemographic characteristic from National Health and however it was not statistically significant. The prevalence by Morbidity Survey 2006, 2011, and 2015 sex has remained static for the past 10 years. In all three Overall 2006 2011 2015 NHMS, the prevalence was higher among respondents from 72,573 34,539 18,098 19,936 rural areas compared to urban, higher at age 60 years and above compared to younger age-groups and highest among Sex, n (%) n % n % n % obese respondent (BMI >30.0 kg/m2). By ethnic background, Male 15,458 44.8 8460 46.7 9483 47.6 Chinese had the highest prevalence in 2006 but this Female 19,081 55.2 9638 53.3 10,453 52.4 decreased in trend in 2015. In fact, the overall mean SBP and Locality (%) DBP were significantly lower by 5.7 mmHg and 3.6 mmHg, Urban 20,492 59.3 10,543 58.3 11,505 57.7 respectively, in the 2015 survey compared to 2006.
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