High blood pressure and cholesterol: signs, normal levels, and how to lower them
High blood pressure (darah tinggi) and high cholesterol rarely cause symptoms, yet together they are the main reasons Malaysians have heart attacks and strokes. Here are the normal levels, what causes them to rise, what really brings them down, and what to expect from medicines.
Key points
- 29.2% of Malaysian adults have high blood pressure and 33.3% have high cholesterol, according to NHMS 2023. Many don’t know.
- High blood pressure usually has no signs. Only a blood pressure check can tell you. A reading of 140/90 or above, on repeated checks, is high.
- There is no safe way to lower blood pressure in 5 minutes. Very high blood pressure with chest pain, breathlessness, weakness or vision changes is an emergency: call 999.
- Cutting salt to less than 1 teaspoon a day, losing weight, exercise and less alcohol can lower blood pressure by several points each.
- Statins lower LDL cholesterol by about 20–55%. True statin side effects are less common than many people think.
How common are they in Malaysia?
According to the National Health and Morbidity Survey (NHMS) 2023:
- 29.2% of adults have high blood pressure, and 11.9% of adults, about 2.7 million people, have it without knowing. Of those who are treated, fewer than half have it under control.
- 33.3% have high cholesterol, and about half of them don’t know.
- More than 60% of adults aged 18 to 39 with diabetes, high blood pressure or high cholesterol were unaware of it.
Ischaemic heart disease, which both conditions lead to, is Malaysia’s leading cause of death. See our article on undiagnosed conditions in young adults.
Blood pressure levels
Blood pressure is written as two numbers: the top (systolic) is the pressure when the heart beats, and the bottom (diastolic) is the pressure between beats. Malaysia’s hypertension guidelines classify it as:
| Reading (mmHg) | Category |
|---|---|
| Below 120/80 | Optimal |
| 120–129 / 80–84 | Normal |
| 130–139 / 85–89 | At risk |
| 140–159 / 90–99 | Stage 1 (mild) hypertension |
| 160–179 / 100–109 | Stage 2 (moderate) |
| 180 / 110 or higher | Stage 3 (severe) |
One high reading doesn’t mean you have hypertension. Doctors confirm it with repeated readings, often at home. See our guide to checking your blood pressure at home. On treatment, the target for most people is below 140/90, and lower for some people with diabetes, kidney disease or heart disease.
Signs of high blood pressure (tanda darah tinggi)
High blood pressure is called a “silent disease”. Most people feel completely well. Headaches, dizziness or tiredness are not reliable signs, and only a blood pressure check can tell you.
When high blood pressure is an emergency
A reading of 180/110 or higher needs prompt medical attention. Call 999 or go to an emergency department straight away if it comes with chest pain, breathlessness, severe headache, confusion, weakness or numbness, difficulty speaking, or vision changes. If you have no symptoms, sit quietly for 5 minutes, recheck, and see a doctor the same day if it is still very high.
What causes high blood pressure? (Punca darah tinggi)
Most high blood pressure has no single cause. It builds up with:
- Too much salt. Malaysians eat around 8 to 9.5 g of salt a day, well above the recommended limit
- Being overweight, and not being active
- Alcohol and smoking
- Getting older, and having a family history
- Stress
Sometimes another condition or medicine is the cause, especially in younger people. Examples include kidney disease, sleep apnoea (heavy snoring with daytime sleepiness), thyroid or hormone problems, and medicines such as anti-inflammatory painkillers, steroids, decongestants and the contraceptive pill. Tell your doctor about any traditional or herbal remedies you take, too.
How to lower blood pressure
Can you lower blood pressure in 5 minutes? No, not safely. Slow, deep breathing may bring it down a little for a short time, and practised regularly it can help a few points. But there is no quick fix, and Malaysian guidelines warn that lowering very high blood pressure too fast can itself cause a stroke or heart attack. If a reading is very high, follow the emergency advice above.
What does work, over weeks to months, according to Malaysia’s hypertension guidelines:
| Change | Typical effect on blood pressure |
|---|---|
| Cut salt to less than 5 g (about 1 teaspoon) a day | Up to about 8/3 mmHg lower in Asian adults with hypertension |
| Lose weight | About 1 mmHg lower per kg lost |
| A healthy diet rich in fruit, vegetables and low-fat dairy | Several points lower |
| 150 minutes of moderate exercise a week | Several points lower |
| Cut down alcohol | About 3/2 mmHg lower |
Cooking with less salt, soy sauce and stock cubes, and choosing fewer processed and hawker foods, makes the biggest difference for most Malaysians.
Blood pressure medicines
If lifestyle changes aren’t enough, or your blood pressure is high, your doctor will prescribe one or more medicines. The main groups are ACE inhibitors, angiotensin receptor blockers (ARBs), calcium channel blockers, diuretics and beta blockers. Common side effects to know:
- ACE inhibitors (names often end in “-pril”): a dry, persistent cough in some people. Your doctor can switch you to an ARB.
- Calcium channel blockers such as amlodipine: ankle swelling, flushing or headache.
- Beta blockers: tiredness and cold hands and feet.
Most people need treatment for life. Don’t stop your medicine when your readings become normal, because that usually means the medicine is working. Talk to your doctor about any side effects instead.
Normal cholesterol levels (kadar kolesterol normal)
A cholesterol test measures several fats in the blood. You usually don’t need to fast. Malaysian guidelines use these levels to flag a problem:
| Test | Flag level (mmol/L) |
|---|---|
| Total cholesterol | Above 5.2 is high |
| LDL (“bad”) cholesterol | Target depends on your heart risk (see below) |
| HDL (“good”) cholesterol | Below 1.0 in men or 1.2 in women is low |
| Triglycerides | Above 1.7 is high |
LDL targets depend on your risk. The higher your risk of a heart attack or stroke, the lower your LDL should be. For people at very high risk, such as after a heart attack or stroke, Malaysia’s 2023 guidelines aim for 1.4 mmol/L or lower and a reduction of more than half. Your doctor will work out your risk using your age, blood pressure, smoking, diabetes and family history.
How to lower cholesterol
- Cut down on saturated fat (fatty meat, coconut milk and ghee-heavy dishes, butter) and avoid trans fats in fried snacks and baked goods.
- Eat more fibre: oats, whole grains, beans, fruit and vegetables. About 3 g of oat beta-glucan a day lowers LDL slightly.
- Choose fewer refined carbohydrates, such as large servings of white rice and sweet drinks.
- Exercise regularly, lose weight if you are overweight, and stop smoking.
How fast? Diet changes take weeks to months. Statins usually reach their full effect within about a month, and doctors recheck cholesterol 1 to 3 months after starting.
Statins are the main cholesterol medicine. They lower LDL by about 20 to 55%, depending on the type and dose, and reduce heart attacks and strokes. Other medicines, such as ezetimibe, can be added.
Side effects of cholesterol medicine (kesan sampingan ubat kolesterol)
Statins are among the most studied medicines in the world, and serious side effects are rare:
- Muscle aches: many people report them, but in trials they happen only slightly more often than with a dummy pill. In one study, people who had stopped statins because of side effects felt almost the same symptoms when taking a placebo. Serious muscle damage is rare. Most people who can’t tolerate one statin do fine on another.
- Liver: a mild rise in liver tests happens in under 3% of people. Liver failure is extremely rare.
- Diabetes: statins slightly increase the chance of developing diabetes, mainly in people already at risk, but the heart benefits are far greater.
Don’t stop a statin on your own. If you have side effects, talk to your doctor about changing the dose or type.
Where to get your blood pressure and cholesterol checked
Any GP clinic can check your blood pressure in minutes and arrange a cholesterol test. Government health clinics offer free checks, and many people qualify for free screening. Our directory lists GP clinics across Kuala Lumpur, Selangor and other states.
Browse the clinic directoryFrequently asked questions
What are the signs of high blood pressure? (Tanda darah tinggi)
Usually none. High blood pressure is a “silent disease”, and only a blood pressure check can tell you. Very high blood pressure with chest pain, breathlessness, severe headache, weakness or vision changes is an emergency.
How can I lower my blood pressure quickly? (Cara menurunkan darah tinggi dengan cepat)
There is no safe way to lower it within minutes, and lowering very high blood pressure too fast can be dangerous. Over weeks, cutting salt, losing weight, exercise and less alcohol all help. If a reading is 180/110 or higher with symptoms, call 999.
What is a normal cholesterol level? (Kadar kolesterol normal)
Malaysian guidelines flag total cholesterol above 5.2 mmol/L, HDL below 1.0 (men) or 1.2 (women), and triglycerides above 1.7. Your LDL target depends on your heart risk.
What are the side effects of cholesterol medicine? (Kesan ubat kolesterol)
Statins can cause muscle aches in some people, mild liver test changes and a slightly higher diabetes risk, but serious side effects are rare. Talk to your doctor rather than stopping it yourself.
Can I stop my blood pressure medicine when my readings are normal?
No. Normal readings usually mean the medicine is working. Most people need it long term. Talk to your doctor before changing anything.
How fast can I lower my cholesterol? (Menurunkan kolesterol dengan cepat)
Statins reach their full effect in about a month. Diet changes take weeks to months. Your doctor will usually recheck cholesterol 1 to 3 months after a change.
Sources
- Ministry of Health — Clinical Practice Guidelines: Management of Hypertension, 5th edition (2018)
- Ministry of Health — Clinical Practice Guidelines: Management of Dyslipidaemia, 5th edition (2017)
- Academy of Medicine of Malaysia — Clinical practice guidelines list (incl. Dyslipidaemia, 6th edition, 2023)
- Institute for Public Health — NHMS 2023 key findings
- Department of Statistics Malaysia — Statistics on Causes of Death, Malaysia 2025
- NHS — High blood pressure (Jul 2024)
- NHS — Side effects of amlodipine (Jun 2026)
- NHS — Side effects of ramipril (Mar 2026)
- Chaddha et al. — Device and non-device-guided slow breathing to reduce blood pressure (2019)
- American College of Cardiology — SAMSON trial summary (Nov 2020)
