Obesity-Related Hypertension: Gender-Specific Analysis Among Adults in Tanjung Karang, Selangor, Malaysia

Authors: Aniza I, Hayati K, Juhaida MN, Ahmad Taufik J, Idayu Badilla I, Khalib L

Affiliation: Department of Community Health, UKM Medical Centre, Kuala Lumpur, Malaysia

Published: 2015 · Malaysian Journal of Public Health Medicine, Vol. 15(1): 41–52

Last reviewed: March 2026

Background and Context

Hypertension and obesity represent two of the most significant non-communicable disease (NCD) risk factors in Malaysia. The age-adjusted prevalence of hypertension among Malaysian adults has been estimated at approximately 42.0%, with rates slightly higher in men (43.5%) than women (41.0%) according to the REDISCOVER Study cohort. Meanwhile, the 2015 National Health and Morbidity Survey found that approximately 51.2% of Malaysian adults were overweight or obese, reflecting a rapidly escalating epidemic with major implications for cardiovascular disease burden.

The relationship between obesity and hypertension is well established in the medical literature. Excess adiposity, particularly visceral fat, drives hypertension through multiple pathophysiological mechanisms including sympathetic nervous system activation, renin-angiotensin-aldosterone system stimulation, insulin resistance, and endothelial dysfunction. However, the specific patterns and determinants of obesity-related hypertension may vary by gender, ethnicity, and geographic context, necessitating locally relevant research to inform targeted prevention strategies.

This study by Aniza and colleagues, published in the Malaysian Journal of Public Health Medicine in 2015, investigated the relationship between obesity and hypertension with a specific focus on gender differences among adults in Tanjung Karang, a predominantly rural, agricultural district in Kuala Selangor.

Study Design and Population

A cross-sectional study was conducted among adult residents of three villages in Tanjung Karang, located in the district of Kuala Selangor, Selangor. The Tanjung Karang area is characterised by a largely rural, agricultural economy with a predominantly Malay population. Data collection involved guided questionnaires and anthropometric measurements including body weight, height, waist circumference, and blood pressure.

Body mass index (BMI) was calculated using the standard formula (weight in kilograms divided by the square of height in metres). Overweight was defined as BMI of 25.0–29.9 kg/m², and obesity as BMI ≥30.0 kg/m², following international WHO classification. Abdominal obesity was assessed using waist circumference measurements, with both Caucasian and Asian-specific cut-off points applied. Hypertension was defined according to established clinical criteria based on measured blood pressure readings and self-reported prior diagnosis.

Key Findings: Gender-Specific Patterns

The study revealed distinct gender-specific patterns in the distribution of obesity and its association with hypertension. The prevalence of abdominal obesity was markedly higher in women than in men, reflecting the well-documented tendency for Malaysian women, particularly in rural settings, to accumulate visceral adiposity. Research conducted in the same Tanjung Karang population found that the prevalence of abdominal obesity based on waist circumference was 66.4% in females compared to 23.8% in males using Caucasian cut-off points.

Despite the higher prevalence of abdominal obesity among women, the relationship between obesity indices and hypertension exhibited both shared and gender-specific characteristics. Among both men and women, increasing BMI was significantly associated with higher blood pressure levels and a greater likelihood of hypertension. However, the relative contributions of different obesity measures (BMI, waist circumference, waist-to-hip ratio) to hypertension risk differed between the sexes, suggesting that the pathophysiological pathways linking adiposity to elevated blood pressure may operate differently or with varying intensity across genders.

National Context: Obesity and Hypertension in Malaysia

The findings from Tanjung Karang were consistent with and reinforced by larger national studies. Baseline findings from the PURE (Prospective Urban Rural Epidemiology) Malaysia Cohort Study reported that 40.7% of Malaysian adults had prehypertension and 38.0% had hypertension. Rural residence, older age, male gender, family history of hypertension, and overweight or obese status were all independently associated with higher odds of both prehypertension and hypertension. Overweight individuals were nearly 3 times (OR: 2.713; 95% CI: 2.333–3.155) and obese individuals approximately 5 times (OR: 4.606; 95% CI: 3.784–5.606) more likely to have hypertension compared to those with normal BMI.

These findings placed the Tanjung Karang results within a broader pattern of escalating NCD risk in rural Malaysia, where traditional dietary patterns are increasingly supplanted by energy-dense diets while physical activity levels decline. The agricultural communities of Tanjung Karang, despite their rural setting, are not immune to the nutritional and epidemiological transitions affecting Malaysia as a whole.

Implications for Prevention and Intervention

The gender-specific patterns of obesity-related hypertension identified in this study carry important implications for public health intervention design. Weight management programmes in rural Malaysian communities need to address the distinct body composition patterns and health behaviours of men and women. For women, targeted interventions addressing abdominal obesity through culturally appropriate dietary counselling and physical activity promotion may be particularly effective. For men, programmes addressing lifestyle factors such as smoking, alcohol use, and dietary habits that contribute to both obesity and hypertension are warranted.

Community-based screening programmes that combine blood pressure measurement with anthropometric assessment can facilitate early identification of individuals at dual risk for obesity and hypertension. Integration of NCD screening and management into primary healthcare services in rural areas, supported by trained community health workers, offers a practical strategy for reaching populations that might otherwise not access preventive care.

Limitations

The cross-sectional design of the study limited the ability to establish causal relationships between obesity and hypertension. The study population was drawn from a specific rural community in Selangor, and findings may not be directly generalisable to urban populations or other ethnic groups in Malaysia. The relatively small sample size may have limited the statistical power to detect smaller but potentially meaningful gender-specific differences. Additionally, the use of single-occasion blood pressure measurements, while standard in community-based studies, may overestimate hypertension prevalence compared to ambulatory monitoring.

Significance for Malaysian Public Health

This study contributed valuable local evidence on the gender-specific relationship between obesity and hypertension in a rural Malaysian community. The findings supported the need for gender-sensitive approaches to NCD prevention and control, particularly in rural areas where healthcare access may be limited. As Malaysia continues to grapple with the dual burden of rising NCD prevalence and persistent health inequities between urban and rural populations, community-level research such as this provides the evidence base necessary for designing effective, contextually appropriate interventions.

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