Clinical Epidemiology of Hypertension in Rural Thailand: A Nationwide Cross-Sectional Study

The clinical epidemiology of hypertension (HTN) in rural Thailand has not been fully reported. We describe factors associated with HTN control and cardiovascular (CV) outcomes in rural Thai communities.

We conducted a cross-sectional study in Thai rural areas in 2024 using a multistage sampling scheme. Eligible participants included adults with HTN receiving care from 36 primary care units across four geographical regions. We used multilevel logistic regression modeling to examine factors associated with HTN control.

We included 1000 participants (68.3% women; mean age, 64.2 years). The HTN control rate was 63.9%, using a threshold of <140/90 mmHg for defining HTN control. When using optimal blood pressure thresholds (<130/80 mmHg for ages 20-64 years; <140/80 mmHg for ages ≥65 years), the HTN control rate was even lower at 47.8%. Factors associated with uncontrolled HTN included younger age, residence in the southern region, no school attendance, adding extra salt to food, low physical activity levels, and obesity. Prevalence of cardiovascular diseases (CVD) in people with HTN was as follows: stroke (10.3%), ischemic heart disease (1.4%), atrial fibrillation (1.2%), and left ventricular hypertrophy (6.0%). A high or very high 10-year CVD risk (i.e., > 20% risk over 10 years) was predicted in 7.9% of individuals with HTN: 12.7% in males and 5.0% in females. Elevated low-density lipoprotein (LDL) cholesterol (≥100 mg/dL) was present in 58.7% of participants; 51.5% had a body mass index of ≥25 kg/m². Life's Essential 8 CV health was categorized as poor, moderate, and high for 8.8%, 83.3%, and 7.8% of participants, respectively.

We highlight a need for improving HTN control in rural Thailand and have identified sociodemographic, lifestyle, and metabolic factors that are associated with a lack of HTN control. Cardiovascular complications remain a significant concern for this population.