Health: A silent killer

Malay Mail: One in three Malaysians aged 30 and above suffers from hypertension while only six out of every 100 have their blood pressure under control, said Malaysian Society of Hypertension president Datuk Dr Azhari Rosman.
“This is more worrisome than the fact that only slightly more than one fifth, or 23 per cent, of Malaysians with high blood pressure are on medication,” says Dr Azhari, a cardiologist at the National Heart Institute.
Dr Azhari adds that the statistics underscore a serious treatment gap involving both patients and doctors.
“The medical community and the public must change their attitudes towards the dangers and the necessity of treating hypertension early and aggressively.”
One reason compliance rates for the treatment of high blood pressure are so low could be that the earlier generation of blood pressure drugs had some side effects, including dizziness, tiredness and some sexual dysfunction, so the treatment was actually causing more symptoms than the disease.
Hypertension-related deaths have been on the rise in Malaysia, partly because many who have high blood pressure do not take their medication.
The number of cases of hypertension in Malaysia almost doubled between 1985 and 1998 – from 58,961 to 103,512. The International Society of Hypertension estimates that about 42 per cent of the world’s population or one in two adults will be hypertensive by 2020.
This has prompted the 2006 National Health and Morbidity Study to probe 70,000 people aged 18 and above in more than 14,000 households to determine the incidence of hypertension, cardiovascular disease and diabetes, says Datuk Dr Zaki Murad Mohd Zaher, chairman of the working group that developed the Malaysian guidelines for the treatment of hypertension on behalf of the Health Ministry and the Academy of Medicine.
Dr Zaki, head of nephrology at Kuala Lumpur Hospital, says that hypertension is a major cause of heart disease, stroke and kidney failure.
“Hypertension is a common problem, but what is worrying is that many people do not know they have high blood pressure. Of those who are aware of their condition, not all are being treated. Even among those who are receiving treatment, only a minority have their blood pressure under control.
“It has been shown in several countries that with good control of blood pressure the incidence of strokes and heart disease can be reduced, saving a considerable sum for the healthcare system.
“A major aspect of the treatment of hypertension is fostering compliance. The choice of medication is also important.
The factors taken into account include absence of major side effects, convenient dosing schedule, cost and any other medical conditions the patient might have. The class of drugs called Angiotensin receptor blockers, or ARB, has few if any side effects and thus may encourage greater compliance.”
Dr Zaki adds that the major challenge is to convince patients to take medication to control their blood pressure, as the condition often presents itself without symptoms.
Fewer than half of the patients with hypertension are successfully on medication, a situation that needs to be looked into. It may mean patients are either non-compliant, not on the right medication or on the right combination of medications. Alternatively it might be that doctors are not aggressive enough in treating their blood pressure.
Says Dr Zaki: “In recent years, it has become apparent that blood pressure should be controlled to a lower level than previously advised to reduce damage to the heart. Meeting these new targets usually requires two or three anti-hypertensive drugs but compliance can be expected to be a problem.”
“High blood pressure is the single most treatable cardiovascular risk factor and Co-Divan is one of the medications I use for ensuring compliance,” he says.
The Co-Divan 160/25mg is a fixed-dose combination of valsartan 160mg (valsartan is an ARB) and 25mg of hydrochlorthiazide (a diuretic). It is a new formulation which has just been launched by Novartis Malaysia, for patients who need additional blood pressure reduction.
The Health Ministry has approved Diovan to improve the survival rate after a heart attack. This approval makes Diovan the only ARB that is indicated for the treatment of post-heart attack, heart failure and hypertension.