By Dr Nor Afiqah bt Nordin / Dr Ang Swee Hung / Professor Dr Moy Foong Ming / Professor Dr Noran Naqiah Hairi

Malaysia recorded 6,976 new COVID-19 cases on 23rd May 2021, the highest number of daily cases reported since the start of the pandemic.

The number of COVID-19 deaths and severe cases which require intensive care have also increased tremendously.

From 1st to 21st May 2021, Malaysia has lost a total of 643 people, close to one third of all COVID-19 deaths in the country since the pandemic started.

Within the same period, patients admitted to ICU increased by 91% (from 337 to 643) and patients requiring ventilation support doubled from 176 to 363.^{1, 2} 

COVID-19 has negatively impacted the care of patients with non-communicable disease such as hypertension and diabetes mellitus.

Hypertension is the most common pre-existing medical condition among COVID-19 patients globally as well as in Malaysia. Patients with hypertension were 95% more likely to require ICU admission and 160% more likely to succumb to the disease. ³

A local study reported that 49% of patients with severe COVID-19 had hypertension, as compared to 13% among mild cases.⁴ 

The high prevalence of hypertension (three in every ten adults) in Malaysia means that a substantial proportion of our adult population is at risk.

The adherence and compliance to medication is crucial. Stopping anti-hypertensive medications could lead to poor blood pressure control, which in turn can result in adverse cardiovascular events such as heart attack, stroke, or kidney failure. All these are linked to poor COVID-19 outcome.

In addition, once the virus enters the body, it could lead to overactivation of the immune system resulting in a cytokine storm, further burdening the cardiovascular and respiratory system which is already in a suboptimal state.

These probably explain why hypertension is the most common comorbidity among COVID-19 patients, especially among those who have severe infection. 

Maintaining a healthy blood pressure (below 140 mmHg/90 mmHg for systolic/diastolic respectively) is important.

Take these steps to control your blood pressure:

1. Know your blood pressure levels. Check and monitor them regularly. This is important to see whether the efforts to control blood pressure are sufficient or should be improved.

2. Limit salt intake in your diet according to the daily recommendations. This can be achieved by carefully inspecting food labels on the content of salt/sodium, avoiding preserved and processed foods and replacing salts with herbs and spices in cooking.

3. Keep your body weight within normal range. For people who are overweight, weight loss of 3–9% from the current body weight has been shown to reduce the blood pressure reading by 3 to 6 mmHg.

4. Exercise consistently. Regular aerobic types of physical exercises such as brisk walking and jogging of at least 150 minutes in a week are recommended, as it is beneficial for the cardiovascular system and lower blood pressure.

5. Quit smoking and avoid alcohol intake as both activities have been shown to increase one's blood pressure.

6. Comply with your current medications and follow-up appointments if you are hypertensive. Be assured that the medications are safe. Do not hesitate to contact your doctor if you are in doubt about your blood pressure control or medications.

Apart from the above-mentioned efforts to control blood pressure, hypertensive patients must follow the standard operating procedures (SOPs) and make every effort to protect themselves from contracting COVID-19.

References:

¹ Situasi terkini COVID-19 di Malaysia 21 Mei 2021: Ministry of Health Malaysia

² Situasi terkini COVID-19 di Malaysia 01 Mei 2021: Ministry of Health Malaysia

³ Hessami A, Shamshirian A, Heydari K, Pourali F, Alizadeh-Navaei R, Moosazadeh M, et al. Cardiovascular diseases burden in COVID-19: Systematic review and meta-analysis. Am J Emerg Med. 2020:S0735-6757(20)30908-6.

⁴ Sim BLH, Chidambaram SK, Wong XC, Pathmanathan MD, Peariasamy KM, Hor CP, et al. Clinical characteristics and risk factors for severe COVID-19 infections in Malaysia: A nationwide observational study. The Lancet Regional Health – Western Pacific. 2020;4.

⁵ Ministry of Health Malaysia. Clinical Practice Guidelines – Management of Hypertension. 5th Edition.: Ministry of Health Malaysia; 2018. Contract No.: MOH/P/PAK/391.18(GU).

⁶ Clark CE, McDonagh STJ, McManus RJ, Martin U. COVID-19 and hypertension: risks and management. A scientific statement on behalf of the British and Irish Hypertension Society. J Hum Hypertens. 2021 Apr;35(4):304-307. doi: 10.1038/s41371-020-00451-x.

(Dr Nor Afiqah bt Nordin, Dr Ang Swee Hung, Professor Dr Moy Foong Ming, Professor Dr Noran Naqiah Hairi, Public Health Department, Universiti Malaya Medical Center, UMMC.)