Hypertension hides in plain Sight

Thailand's economy has surged. Its health care system is admired. Yet a silent killer is quietly stealing lives, straining hospitals, and sapping the nation's future. That killer is hypertension -- and it's hiding in plain sight. 

Hypertension, or high blood pressure, is often called the "silent killer" for good reason. It creeps up with no symptoms, quietly damaging the heart, brain, kidneys, and blood vessels. It doesn't just hurt individuals and families -- it burdens our health system with avoidable costs and robs the economy of productivity through absenteeism and premature death.
The burden of hypertension in Thailand is already enormous and growing. One in four Thai adults has high blood pressure. Three out of four people with high blood pressure do not have it under control, putting them at risk of heart disease, stroke, kidney disease and dementia.

Yet hypertension can be avoided and controlled, as other countries have shown.

Twenty-five years ago, Thailand and South Korea were at the same starting point. Both countries had a blood pressure control rate of just 8%. Today, South Korea boasts the world's highest rate at 62%, while Thailand lags far behind at 23%. South Korea has managed to reduce its death rate from stroke by an astonishing 83%. In contrast, stroke remains the leading cause of death in Thailand, and a staggering 58% of strokes are attributed to uncontrolled blood pressure. Canada, Costa Rica, and other countries have also delivered comprehensive national hypertension programmes and shown notable improvements with control rates over 50%.

The financial consequences of low hypertension control rates are severe. Treating complications from hypertension -- including stroke rehabilitation, heart surgeries, and lifelong dialysis -- is expensive. Thailand's universal health coverage (UHC) system absorbs much of this cost, but the economic toll from lost productivity, caregiving responsibilities, and long-term disability is also immense, particularly because one-third of hypertension-related deaths affect people below the age of 70. In a country proud of its health achievements, one must ask: why is a preventable and treatable condition allowed to wreak such havoc?

Thailand has built an impressive health infrastructure. Its primary health care network is among the strongest in the region. The country provides free health care for all. There is a robust electronic health system and a highly trained health workforce. All the tools needed to address this hypertension crisis are available. But they are not used to full effect.

Experience in South Korea and other countries shows us what's possible. There are three key lessons we can draw from their successes.

First, Thailand should singularly focus on improving blood pressure control from the current level of 23% to at least 50%. While the country has already implemented universal blood pressure screening for all patients visiting a health facility, many patients with high blood pressure are not being linked to care and are slipping through the cracks. Thailand's million Community Health Volunteers can be used to not only support accurate blood pressure measurement at health facilities but also efforts to link people with hypertension to treatment and continuing care. At the same time, incentive structures could reward high-performing clinics that successfully control blood pressure.

Second, research and experience in various countries show that simpler treatment protocols and combination pills help achieve better adherence and blood pressure control. If patients need to take fewer pills, or even a single pill, they are more likely to stay on treatment. The Thai Hypertension Society recommends a single-pill combination therapy in which two or more medications are combined into one pill. While these options can be more expensive, the benefits outweigh the costs.

Third, prevention is just as important as diagnosis and treatment. Thailand has been recognised by the WHO for eliminating trans fat from its food system and for its efforts on obesity management. It is currently taking bold, commendable steps toward prevention: banning marketing of unhealthy food to children and introducing a salt tax -- a first for the region. Next, the country should consider promoting potassium-enriched, low-sodium condiments, which are proven to lower blood pressure at the population level. These public health measures will go a long way in steering people toward healthier choices, including to prevent and control hypertension.

Thailand has a proud history of public health leadership. From slashing childhood mortality, to pioneering HIV prevention, to enacting some of the world's strongest tobacco control policies, the country has consistently shown that when it commits, it leads.

But today, the biggest killers in Thailand -- stroke and heart disease -- are not being met with the urgency they demand. Hypertension is the common thread linking both.

The solutions are known, the tools are available, and the time is now. On this World Hypertension Day, we urge Thailand to act decisively and ambitiously to control high blood pressure. Let's stop the silent killer before it claims more lives.

Published to mark World Hypertension Day on 17 May, this op-ed is co-authored by Dr Jos Vandelaer, WHO Representative to Thailand, and Dr Renu Garg, Senior Vice President for Cardiovascular Health at Resolve to Save Lives.