1) Hypertension prevalence in Thailand is approximately 22%, slightly higher in men, and control of hypertension lags behind awareness and treatment. 2) Excessive salt intake is a major cause of hypertension in Thailand, with daily salt intake averaging over 9 grams compared to the WHO recommended 5 grams. 3) The Thai Hypertension Guidelines recommend starting with ACE inhibitors or ARBs for those under 55 and calcium channel blockers for those over 55, adding additional drugs like diuretics as needed to control blood pressure.

1. Practical Approach to Hypertension
Management Challenge for 2012

2. Prevalence of HTN by Country
70
60
Percentage of Population
50
40
30 Men
20 Women
Men and Women
10
0
*Wolf-Maier K, et al. JAMA. 2003; 289: 2363–2369; age-adjusted prevalence in persons 35 64 y
†Martiniuk AL, et al. J Hypertens. 2007; 25:73–79; age-adjusted prevalence in persons ≥20 y
‡Joshi SR, et al. Diabetes Technol Ther. 2011 Nov 3. [Epub ahead of print]; in persons ≥18 y
2

3. Current Prevalence in Thailand
• Prevalence of HT was 22.0% * and 21.4%, slightly higher in
men.*
• Thai Ministry of Public Health established goals:
– 60% of Thai adults aged ≥ 40 yrs should have their BP
measurement
– 70% of HT should be aware of their condition
– 50% of HT should have their BP control
National Health Examination Survey IV. 2008-2009.

4. Prevalence of Hypertension in Thailand
(Age ≥ 15years NHES4, 2008)
[BP 140/90 mmHg +/- current treatment]
Unaware
No Treatment
Uncontrolled
Well controlled
National Health Examination Survey
Prevalence of HT = 21.4%
2008
National Health Examination Survey
2009

5. Control of HTN Lags Awareness and
Treatment
Awareness, Treatment, and BP Control Rates Among
Hypertensive Adults in Thailand (NHES4th 2008–2009)
70
60
50
Patients (%)
40
30
20
10
0
Awareness Treatment BP controlled
North
5 Central Northeast South Bangkok
NHESO =National Health Examination Survey Organization

6. Blood Pressure
has multiple regulatory pathways
Patient 1 Patient 2 Patient 3
Sympathetic nervous system
Renin-angiotensin system
Total body sodium
B. Waeber, March 2007, with kind permission

7. Salt intake: cross country comparison
The recommended level of salt consumption of WHO is no more than 5 g/day.
14
12.3
12
10.9
Daily mean intake of salt (g)
10.8
10.1
10 9.6 9.7
8.3 8.6 8.5
8 7.7
7.1 7 7.2 All
6.4
6
5.8 Males
Females
4
2
0
0
*
Singapore Malaysia
** *
Thailand **
Japan UK*
* US* *
Canada
* * Data obtained via 24-hr urine analyses, which is considered the “gold standard” method to estimate salt intake in the population
* Data obtained through dietary surveys (generally tend to underestimate sodium intakes)
Singapore 2010 Salt Intake Study

8. Excessive Salt intake is
a major cause of hypertension
Salt appears to underpin the link between
Hypertension and stroke in Asian patients
Stoke mortality is generally higher in Asian
Countries than in Western countries
The incidence of hemorrhage stroke in East Asian
Countries is relatively higher than in Western countries
High salt intake is thought to account for the excess
Stroke mortality seen in Asian populations
Thai patients with severe hypertension
and a High-salt diet require acute therapy
to reduce BP

9. Thai Hypertension Guidelines
<55 >55
Step 1 A C/D
Step 2 A+C/D C /D+A
Step 3 A+C+D
Step 4 A+C+D
spironolactone 25
: A: ACEI or ARB ( ACEI
furosemide ARB) -blocker -
C: calcium channel blocker diuretic)
blocker
D: diuretic
Thai Hypertension Society 2012