Malaysian Society of Hypertension

11th Annual Scientific Meeting

Symposium I
Reality Check: Burden of Hypertension and Current Scenario

Lecture

Hypertension in the Philippines

DANTE D. MORALES, M.D., FPCP, FPCC, FACP, FACC

Immediate Past President, Philippine Society of Hypertension
Associate Clinical Professor, U.P. College of Medicine
Senior Vice-President for Medical Affairs, Manila Doctors Hospital

Jan. 17, 2014 Shangri-la Hotel,

Kuala Lumpur, Malaysia
 Agenda
n  Background: Population, Morbidity and
Mortality in the Philippines
n  National Nutrition Survey (NNS) &
National Nutrition & Health Survey(NNHeS)
•  Scope, coverage, sampling design
•  Components and organization
n  Prevalence of hypertension (HPN)
•  Prevalence, population means
•  HPN & modifiable risk factors in MI & Stroke
•  Factors for uncontrolled HPN

Initiatives
2
 Philippine Population
100,000,000

95,000,000

90,000,000

85,000,000

89.468,680

97.976,600
92.937,852
84,619,980

80,000,000

75,000,000
2003 2006 2009 2013

Republic of Philippines OFFICIAL Statistics,

Census Years, National Statistics Office.
Deaths  by  cause,  all  ages,  per  100,000  populaEon,  
Philippines,  2009  
Diseases  of  the  heart  

3%  3%   Diseases  of  the  vascular  system  

6%  
Malignant  neoplasms  
26%  
6%  
Pneumonia  

Accidents  
7%  
TB,  all  forms  

9%   Chronic  lower  respiratory  infecEons  

17%   Diabetes  

11%   NephriEs,  NephroEc  diseases  

12%   Certain  condiEons  during  perinatal  

period  
 Ten Leading Causes of Mortality
Philippines, 2009
Cause Number Rate
per 100,000
population

1. Diseases of the Heart 100,908 109.4

2. Diseases of the Vascular System 65,489 71.0

3. Malignant Neoplasm 47,732 51.8

4. Pneumonia 42,642 46.2

5. Accidents 35,990 39.0

6. Tuberculosis, all forms 25,470 27.6

7. Chronic lower respiratory diseases 22,755 24.7

8. Diabetes Mellitus 22,345 24.2

9. Nephritis, Nephrotic Syndrome and Nephrosis 7,963 10.4

10. Certain conditions originating in the perinatal 11,514 12.5

period 5

Source: Philippine Health Statistics, 2009

 Ten Leading Causes of Morbidity
Philippines, 2009
Cause Number Rate
per 100,000
population
1. Acute respiratory infection 1,095,328 1203.0
2. Acute lower respiratory tract 557,786 612.6
infection & pneumonia
3. Bronchitis/Bronchiolitis 346,627 380.7
4. Hypertension 333,497 366.3
5. Acute watery diarrhea 322,799 354.5
6. Influenza 271,011 297.7
7. Urinary tract infection 82,867 91.0
8. TB Respiratory 73,614 80.9
9. Injuries 35,396 38.9
10. Acute febrile illness 20,250 22.2

Source: Philippine Health Statistics, 2009

 National Nutrition Survey
Presidential Executive Orders:
1987 - mandated FNRI to define the citizenry’s
FNRI nutritional status particularly on
malnutrition’s causes and effects, and
FOOD AND
NUTRITION identify alternative solutions
RESEARH
INSTITUTE
1996 - designated FNRI to:
DEPARTMENT OF
SCIENCE AND
TECHNOLOGY
1.  Generate clinical data for decision making of
the government & private sector
2.  Conduct National Nutrition Survey (NNS)
every 5 years at the national & regional
levels
Medical specialty organizations collaborated &
contributed to the surveys of 1998, 2003,
2008 & 2013
7 thNational Nutrition Survey
(NNS): Philippines, 2008

- most recent survey done

- started in May 2008 and ended

in Dec 2008

- 8th NNS started in June 2013

to end 1st quarter of 2014
 Scope & Coverage

n  All 17 Regions

LUZON
n  79 Provinces & NCR
n  3,377 Enumeration
Areas
VISAYAS
n  36,633 Households
MINDANAO n  191,351 Individuals

Total  PopulaEon  20  years  and  above:  45M            Eligible  subjects  represenEng    45M:    7700    
Adopted NSO’s 2008
Labor Force Survey (LFS) ALL 17 Regions
Sample (4 replicates) REG/PROV 79 Provinces incl Batanes

1st One bgy or contiguous

PRIMARY bgys w/ at least 500
Stage SAMPLING UNIT households (HHs)

ENUMERATION Contiguous area in

2nd a bgy w/ 150-200
Stage AREAS (EAs) HHs

Sample households
3rd for all members of
each sample HH
Stage
 8 Components of the 7th NNS
A nthropometric
B iochemical
C linical and Health
D ietary
E conomic
F ood Insecurity
G overnment program participation
H ealth

7th National Nutrition Survey: Philippines, 2008

 8 Components of the 7th NNS
A nthropometric
B iochemical
C linical and Health
D ietary
E conomic
F ood Insecurity
G overnment program participation
H ealth

7th National Nutrition Survey: Philippines, 2008

7th NNS : Philippines,
2008 –
Clinical and Health
Component
or
National Nutrition and
Health Survey II
(NNHeS II) : 2008
The Whole Philippines
 The National Nutrition and Health
Survey II:2008
or NNHeS II:2008
Steering Committee (7):
Chair: Dante D. Morales, M.D.
Co-Chair: Rody Sy, M.D.
Members:
FNRI - Mario Capanzana, M.D.
DOH - Precy Cuevas
PHA - Teresa Abola, M.D.
PLAS - Nelson Abelardo, M.D.
PSH - Abdias Aquino, M.D.

Technical Committee (4):

Chair: Antonio L. Dans, M.D.
Co-Chair: Felix Eduardo Punzalan, M.D.
Members:
Charmaine Duante
Ma. Vanessa V. Sulit
 Participating & Contributing Medical Organizations
Medical Organizations   1998   2003   2008  
1. Philippine Lipid & Atherosclerosis Society (PLAS)   P   P   P  
2. Philippine Society of Hypertension (PSH)   P   P   P  
3. Philippine Diabetes Association (PDA)   P   P   ×  
4. Philippine Heart Association (PHA)   P   P  
5. Philippine Pediatric Society (PPS)   P   ×  
6. Philippine Society of Nephrology (PSN)   P   P  
7. Philippine Society of Endocrinology and Metabolism (PSEM)   P   P  
8. Osteoporosis Society of the Philippines (OSPFI)   P   P  
9. Philippine Assoc. for the Study of Overweight & Obesity (PASOO)   P   P  
10. Philippine Neurological Association (PNA)   P   ×  
11. Philippine Rheumatology Association (PRA)   P   P  
12. Philippine Society of Gastroenterology (PSG)   P   ×  
13. Philippine College of Physicians (PCP)   P   P  
14. Philippine Society of Asthma, Allergy and Immunology (PSAAI)   P   P  
15. Philippine Society of Vascular Medicine (PSVM) P  
16. Hepatology Society of the Philippines P  
 The National Nutrition and
Health Survey II:2008
or
NNHeS II:2008

PREVALENCE OF
HYPERTENSION IN THE
PHILIPPINES
-ADULT POPULATION 20 YEARS & ABOVE
 Prevalence of Atherosclerosis-Related Risk
Factors and Diseases in the Philippines

Rody G. Sy1, Dante D. Morales1, Antonio L. Dans2, Elizabeth Paz-Pacheco3,

Felix Eduardo R. Punzalan1, Nelson S. Abelardo1, and Charmaine A. Duante4

1
Section of Cardiology, Department of Medicine, College of Medicine, University of
the Philippines (UP) System, Manila, Philippines
2
Section of Adult Medicine, Department of Medicine, College of Medicine, UP System,
Manila, Philippines
3
Section of Endocrinology, Diabetes and Metabolism, Department of Medicine,
College of Medicine, UP System, Manila, Philippines
4
Food and Nutrition Research Institute, Department of Science and Technology, Taguig,
Philippines

Sy RG, Morales DD, et al; Prevalence of Atherosclerosis-Related Risk Factors and

Diseases in the Philippines. Journal of Epidemiology 2012; 22 (5):440-447.
Profile of Responders and Nonresponders in NNHeS 2008
Parameter Responders Nonresponders P-value
Blood Pressure
Mean age, y 42.6 40.3 0.0007
Sex
Male, % 45.5 54.2 0.0035
Female, % 54.5 45.8 0.0077
Blood lipids
Mean age, y 43.4 38.4 0.0000
Sex
Male, % 46.9 43.8 0.1725
Female, % 53.1 56.2 0.1211
FBG
Mean age, y 43.5 38.3 0.0000
Sex
Male, % 46.8 44.3 0.2430
Female, % 53.8 55.7 0.1882
Questionnaires
Mean age, y 42.6 40.3 0.0003
Sex
Male, % 45.4 58.5 0.0000
Female, % 54.6 41.5 0.0003
 BP Classification and Criteria
BP Systolic BP Diastolic BP
Classification (mm Hg) (mm Hg)

Normal < 120 and < 80

High Normal 120-129 or 80-84

Pre-Hypertension 130 -139 or 85-89

Hypertension
Stage I 140 -159 or 90-99
Stage II >160 or > 100

Based on The Joint National Committee on Detection, Evaluation and Treatment

of High Blood Pressure (JNC VII)
 Prevalence (%) of Hypertension by
Sex (Philippines 2003 and 2008)
Age-adjusted Unadjusted

2003 2008 2003 2008

% (95% Cl) % (95% CI) % (95% CI) % (95% CI)
Men
HPN, single visit 24.5 (21.4, 27.6) 28.4 (25.7, 31.1) 24.2 (23.2, 25.2) 29.1 (26.7, 31.6)
HPN, true prevalence 19.0 (16.6,21.4) 24.1 (22.9, 25.3 18.4 (16.9, 19.9) 28.3 (26.8, 29.8)
Women
HPN, single visit 18.4 (19.8, 21.8) 21.4 (18.9, 23.9) 20.8 (19.8, 21.8) 222 (20.1, 24.3)
HPN, true prevalence 12.9 (10.9, 14.9) 17.4 (16.0, 18.8 16.5 (15.0, 18.0) 23.5 (22.0, 24.8)

All
HPN, single visit 21.6 (19.6, 23.6) 24.6 (22.7, 26.5) 22.5 (21.5, 24.7) 25.3 (23.6, 27.1)
HPN, true prevalence 16.4 (14.8, -18.0) 20.6 (19.4, 21.8 17.4 (15.9, -18.9) 25.7 (24.5, 26.8)

Abbreviation: FBG, fasting blood glucose; 2-hr PG load, 2-hour post-load plasma glucose level; BMI,body mass
index; WHR, waist hip ratio; CAD, coronary artery disease; PAD, peripheral artery disease.

Sy RG, Morales DD, et al; Prevalence of Atherosclerosis-Related Risk Factors and

Diseases in the Philippines. Journal of Epidemiology 2012; 22 (5):440-447.
 Trends in the Prevalence of Hypertension
among Adults in the Philippines: 1998, 2003
and 2008 Unadjusted for Age
30
25.3 25.7
25 22.5
21

20 17.1 17.4
1998
15
2003

10 2008

0
Single visit True Prevalence
Sy RG, Morales DD, et al; Prevalence of Atherosclerosis-Related Risk Factors and
Diseases in the Philippines. Journal of Epidemiology 2012; 22 (5):440-447.
 Trends in the Prevalence of Hypertension
among Adults in the Philippines: 2003 and
2008 Adjusted for Age
30

24.6
25
21.6
20.6
20
16.4

15 2003
2008
10

0
Single visit True Prevalence
Sy RG, Morales DD, et al; Prevalence of Atherosclerosis-Related Risk Factors and
Diseases in the Philippines. Journal of Epidemiology 2012; 22 (5):440-447.
 Population Means for Hypertension by
Sex (Philippines 2003 and 2008)
Unadjusted Age-adjusted
2003 2008 2003 2008
Mean (95% Cl) Mean (98% CI) Mean (95% Cl) Mean (95% Cl)

Men
SBP, mmHg 123.1 (122.2, 124.1) 123.0 (122.3, 123.7) 123.5 (122.6, 124.4) 122.8 (122.2, 123.6)
DBP, mmHg 78.4 (77.8, 79.1) 80.8 (80.3, 81.3) 78.4 (77.7, 79.0) 80.7 (80.2, 81.1)

Women
SBP, mmHg 119.7 (118, 120.9) 118.7 (118.0, 119.4) 117.9 (117.0, 118.8) 118.0 (117.4, 118.6)
DBP, mmHg 75.3 (74.6, 76.0) 77.0 (76.6-7.5) 74.6 (74.0, 75.2) 76.7 (76.3, 77.2)

All
SBP mmHg 121.5 (120.7, 122.7) 120.7 (120.1, 121.25) 121.0 (120.3,121.7) 120.2 (119.7,120.7)
DBP, mmHg 76.8 (76.3, 77.4) 78.8 (78.4,79.1) 76.6 (76.2, 77.1) 78.6 (78.2, 78.9)

Abbreviations: LDL, low-density lipoprotein; HDL, high density lipoprotein; BMI, body mass index, SBP,
systolic blood pressure, DBP, diastolic blood pressure

Sy RG, Morales DD, et al; Prevalence of Atherosclerosis-Related Risk Factors and

Diseases in the Philippines. Journal of Epidemiology 2012; 22 (5):440-447.
Mean systolic BP and diastolic BP (mm Hg)
among adults based on a single visit BP, by
age, Philippines – NNHeS II: 2008

Age Mean SBP Mean DBP

(y) (mm Hg) (mm Hg)

20-29 112.2 74.5

30-39 116.1 77.7
40-49 122.6 81.3
50-59 131.2 84.2
60-69 136.2 82.5
>70 140.2 81.3
Overall 120.7 78.8
Treatment Gap

Prevalence, Awareness and

Treatment of Hypertension by Sex
Males   Females   Total  

n  (%)   Corrected   n  (%)   Corrected   n  (%)   Corrected  

Prevalence   882  (28.5)   18.7   1089(26.8)   16.7   1971  (27.7)   17.7  

Aware   422  (41.7)   656  (60.7)   1078  (50.7)  

Treated   114  (10)   229  (16.6)   343  (13.1)  

Controlled   136  (15.8)   198  (23.2)   334  (19.3)  

Unpublished NNHeS 2003 Estimated Prevalence, Awareness and Treatment of

Hypertension in Adults 20 years or more
PRESYON 3
Report of the Council on Hypertension. Phil Heart Assn.

Results: Prevalence of Hypertension in Adults

- 28% (F: 50%, M: 50%)*

%
28
25.3
22 22.5 21
11

Nationwide PRESYON 1 NHES PRESYON 2 NHES

Registry
PRESYON 3
 Patients Prevalence Awareness Treated Controlled
Country
(n) (%) (%) (%) (%)
China1 13,364 43.8 26.2 22.2 3.9

India2 4,711 36.0 22.1 36.7 _

Korea3
6,388 43.8 60.1 91.7 27.2
(>40 years, rural areas)
Korea4
8,485 24.9 63.5 54.8 38
(≥30 years)
Malaysia5
33,976 32.2 35.8 31.4 26.3
(>18 years)
Philippines6
(2003) 1,971 17.7 50.7 13.1 19.3
(2008) 20.6 35.4→40.9
Singapore7 5,022 41.5 51.8 84.4 27.1
Indonesia
9,348 31.7 _ _ _
(>18 years)8

1.  Li H, et al. J Hypertens 2010;28:432-8.

2.  Sharma AK, et al. Indian Heart J 2006;58:21-7. 7. Wu Y, et al. J Hypertens 2009;27:190-7
3.  Lee HS, et al. Clin Exp Hypertens 2010;32:166-78. 8. Basic Health Researches, 2008. Indonesian Health
4.  Korean National Health and Nutrition Examination Survey Department (c/o Dr Arieska Ann Soenarta).
(KNHANES) 2008 [Korean]. Available at: http://knhanes.cdc.go.kr.
5.  Institute of Public Health (IPH) 2008. The Third National Health and
Morbidity Survey 2006 Vol. 2. Ministry of Health Malaysia
pp 199-316 ISBN 978-983-3887-30-9.
6.  Dans AL et al. Unpublished NNHeS 2003 Estimated Prevalence,
Awareness and Treatment of Hypertension in Adults 20 years or more
 Worldwide Prevalence of HTN is High*
Germany7
Finland7
Spain7
England7
Sweden7
Italy7
Japan8
Egypt9
South Korea9 †
United States7
Canada7
Taiwan9
Philippines10

0 10 20 30 40 50 60 70

*Defined as systolic/diastolic blood pressure ≥140/90, (≥160/95 for Taiwan) or receiving treatment.
†South Korea is defined as men, aged 30-59.
7. Wolf-Maier et al. JAMA 2003;289:2363-2369; 8. Data on file, Pfizer, Inc, New York, NY;
9. WHO Collaborating Center on Surveillance of Cardiovascular Disease Web site. Available at www.cvdinfobase.ca.
Accessed Feb. 22, 2005
10. National Nutrition & Health Survey (NNHeS:2003-2004). Dans, AL, Morales DD et al. Phil J Int Med, May-June 2005
10. Sy RG, Morales DD, et al; Prevalence of Atherosclerosis-Related Risk Factors and Diseases in the Philippines. Journal
of Epidemiology 2012; 22 (5):440-447.
 Global Prevalence of Hypertension by WHO
Regions, 2008
Prevalence of High Blood Pressure in Adults ≥25 Years Old

Global

Africa

Eastern Meditteranean

Europe

Western Pacific

Southeast Asia

Americas

0 5 10 15 20 25 30 35 40
Prevalence, %

WHO=World Health Organization

World Health Organization. World Health Statistics. 2012.
 NNHeS I & II: 2003 & 2008 : Prevalence of Atherosclerosis-
Related Risk Factors & Diseases- Age Adjusted

Risk factors Prevalence (C.I. ) in %

2003 2008
Hypertension (Age-adjusted) 16.4 (10.8-18.0) 20.6 (19.4-21.8)

Diabetes by FPG and Hx 4.6 (2.2-7.0) 5.2 (3.1-7.3)

Smoking 35.9 (33.6-38.2) 31.0 (29.1-32.9)

Dyslipidemia 62.3 (60.5-64.0) 72.0 (70.7-73.3)

Obesity (BMI ≥ 30) 4.7 (1.6-7.7) 4.9 (2.5-7.3)

Overweight (BMI ≥ 25) 19.7 21.4
Obesity by WHR ,M 12.0 (10.4-13.7) 10.2 (9.3-11.2)

Obesity by WHR, F 53.0 (50.0-56.0) 65.6 (63.9-67.3)

2003 – Dans A, MoralesD, et al. Phil J Intern Med 2005;43:103-115.

2008 – SyR, MoralesD, et al. for publication - Journal of Epidemiology 2012
 NNHeS I & II: 2003 & 2008 :
Prevalence of Atherosclerosis- Related Risk Factors
& Diseases- Age Adjusted
Risk factors Prevalence (C.I. ) in %

2003 2008
Hypertension (Age-adjusted) 16.4 (10.8-18.0) 4 20.6 (19.4-21.8) 4

Diabetes by FPG and Hx 4.6 (2.2-7.0) 6 5.2 (3.1-7.3) 5

Smoking 35.9 (33.6-38.2) 2 31.0 (29.1-32.9) 3

Dyslipidemia 62.3 (60.5-64.0) 1 72.0 (70.7-73.3) 1

Obesity (BMI ≥ 30) 4.7 (1.6-7.7) 5 4.9 (2.5-7.3) 6

Overweight (BMI ≥ 25) 19.7 21.4
Obesity by WHR ,M 12.0 (10.4-13.7) 3 10.2 (9.3-11.2) 2

Obesity by WHR, F 53.0 (50.0-56.0) 3 65.6 (63.9-67.3) 2

2003 – Dans A, MoralesD, et al. Phil J Intern Med 2005;43:103-115.

2008 – SyR, MoralesD, et al. for publication - Journal of Epidemiology 2012
 ESTIMATED NO. OF DEATHS FROM
Coronary Artery Disease (CAD) &
STROKE (CVD) FOR ALL RISK FACTORS

RISK FACTOR CAD CVD TOTAL

DEATHS DEATHS DEATHS
SMOKING 19,315 29,184 48,499

HPN 15,559 25,401 40,960

OBESITY
WHR: M/F 3,322/11,518 20,207 35,047
BMI 644 2,648 3,292
CHOL 8,799 4,053 12,852
DIABETES 3,326 6,864 10,190

Adapted from Sy RG, Morales DD, et al; Prevalence of Atherosclerosis-Related Risk Factors
and Diseases in the Philippines. Journal of Epidemiology 2012; 22 (5):440-447.
 Modifiable Risk Factors
INTERSTROKE (Brain Attack) INTERHEART (Heart Attack)
1.  Hypertension (2.64) 1. APoB:A1 LDL/HDL
2. Cardiac (2.38) 2. Current Smoking
3. Current Smoking (2.09) 3. Psych. Stress
Depression
4. APoB:A1 LDL/HDL (1.89) 6. DM
5.  WHR (1.65) 4. Hypertension
6.  Alcohol (1.51 [>30 cans/mo]) 5. WHR
7.  DM (1.36) 7. Lack of exercise
8.  Diet (1.35) 8. Lack of fruits and vegetables
9.  Psych. Stress (1.30) 9. Lack of small amount of alcohol
Depression (1.35)
10. Reg. PA (0.69)
Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART
study): case-control study. Salim Yusuf, Steven Hawken, Stephanie Ôunpuu, Tony Dans, et al on behalf of the INTERHEART
Study Investigators. Lancet 2004; 364: 937–52

Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study.
Martin J O’Donnell MD, Dennis Xavier MD, Lisheng Liu, MD, Prem Pais, MD, Antonio Dans, MD, Salim Yusuf on behalf of the
INTERSTROKE Investigators. Lancet Vol 376, Issue 9735, pp112-123, 10 Jul 2010
 Factors for Uncontrolled Hypertension among
Hypertensive Patients Managed by Physicians
Practicing in Metro Manila, Philippines

Research Question:
Among Filipinos, what are the factors for uncontrolled
hypertension among patients managed by physicians
practicing in Metro Manila?

Philippine Heart Association - Council on Hypertension and Committee on Research. Eugene Reyes. Noemi Pestano et al:
Factors for Uncontrolled Hypertension Among Hypertensive Patients Managed by Physicians Practicing in Metro Manila,
Philippines. Research Paper Presentation. May 25, 2011
 Objectives:
1.  To present the prevalence of uncontrolled hypertension in
the Philippines.

2.  To discuss the risks associated with poor blood pressure

control.

3.  To enumerate the factors that affect blood pressure

control.

4.  To provide strategies that may improve blood pressure

control.

1.  Research design: Cross-sectional analytical design

2.  Personal face-to-face interview, aided by a validated
structured questionnaire (trained research field personnel)
Philippine Heart Association - Council on Hypertension and Committee on Research. Eugene Reyes. Noemi Pestano et al:
Factors for Uncontrolled Hypertension Among Hypertensive Patients Managed by Physicians Practicing in Metro Manila,
Philippines. Research Paper Presentation. May 25, 2011
Factors Affecting Poor BP Control
n  Patient Factors n  Socioeconomic Factors
1.  Presence of co-morbid conditions (e.g. 1.  Type of Drug Used
DM, MI) 2.  Social Class of Patient
2.  Education of Patient 3.  Class of Drug Used
3.  Increasing no. of current medication
4.  Duration of HPN
5.  Gender of Patient
6.  Age of Patient
n  Behavioral Factors
n  Physician Factors 1.  Adherence to Medication
1.  Knowledge of Guidelines 2.  Smoking
2.  Type of Drug Used 3.  Alcohol Intake
3.  MD- type of practice
4.  Class of Drug Used
5.  MD- duration of practice
 Results
Variable P Value
0.0   0.5   1.0   1.5   2.0   2.5   3.0   3.5   4.0   4.5   5.0   5.5   6.0   6.5   7.0   7.5   8.0   8.5   9.0   9.5

5.50  
Presence of DM 0.0000
0.55  
Knowledge of Guidelines 0.0819
0.69  
Type of Drug Used* 0.0389
0.49  
Adherence to Medication 0.0706
1.36  
MD- type of practice
History of prior MI
0.0785
0.3512
0.69   Multivariate Analysis
0.99  
Smoking 0.9915
1.22  
Social Class of Patient 0.2826
0.94  
Education of Patient 0.7280
0.56  
Class of Drug Used** 0.009
1.16   *Type of Drug Used:
MD- duration of practice 0.4380
1.57   Branded vs Generic
Increasing no. of 0.0199 **Class of Drug Used:
current medication 1.04   ARB vs Non ARB
Alcohol Intake 0.8364
0.86  
Duration of HPN 0.5616
1.37  
Gender of Patient 0.1226
0.84  
Age of Patient 0.3223
Factors for Uncontrolled Hypertension Among Hypertensive Patients Managed by Physicians Practicing in Metro Manila, Research
Paper Presentation. May 25, 2011
 Factors Affecting BP Control

•  Factors Associated With Poor BP Control

1)  Presence of diabetes mellitus
2)  Increasing number of medications taken (2 or more)

•  Factors Associated With Good BP Control

1)  Type of drug used by patients (Branded only)
2)  Class of drug used (ARB)
3)  Good adherence

Philippine Heart Association - Council on Hypertension and Committee on Research. Factors for
Uncontrolled Hypertension Among Hypertensive Patients Managed by Physicians Practicing in Metro
Manila, Philippines. Research Paper Presentation. May 25, 2011
Globalization Smoking Diabetes Heart Disease
Urbanization Poor Diet HPN Stroke
Aging Group
Inactivity Dyslipidemia Cancer
Poverty
Obesity Chronic Lung
Low Educ
Abnormal Disease
Stress
Lung Fn

GUAPLES

Predisposing Behavioral Risk Intermediate

Chronic NCD
Environment Factors Risk Factors

The Rise of Chronic Non-communicable Diseases in Southeast Asia: Time for

Action. Dans, A., Ng, N., Bonita, R. et al. The Lancet, 377:9766 pp 680-689.
 Initiatives
n  Emphasize on preventive interventions with
low cost but high health impact
n  Increase compliance with low cost
medicines
n  Implement population interventions: salt
reduction, food labeling, tobacco control &
multi-drug treatment
n  Integrate non-communicable disease
prevention and control programs
n  Establish coalition of medical associations
n  Public Private Partnership: DOH, FNRI-
DOST and other governmental agencies
41
Control Rate in Philippines & Metro Manila
BP Control Rate (Adults ≥ 18 years)

Philippines1 Metro Manila2

20% 24%

76%
80%

*94/ 469 = 20% *240/ 1000 = 24%

Sison  et  al.  PRESYON  2    Presented  at  the  PHA  Annual  ConvenEon,  May  2007  1  
Factors for Uncontrolled Hypertension Among Hypertensive Patients Managed by Physicians Practicing in Metro Manila,
Philippines. Research Paper Presentation. May 25, 2011, in press 2
 Hypertension
Awareness, Treatment, and Control US and Europe
Age-Adjusted Hypertension Awareness, Treatment, and Control
80 in the Population Aged 35–64 Years at the 140/90 mm Hg Threshold

70
% of the population

60

50

40

30

20

10

CANADA USA ITALY SWEDEN UK SPAIN GERMANY

Katharina Wolf-Maier; Richard S. Cooper; Holly Kramer et al,
Hypertension , 2004; 43:10
 NNHeS I & II: 2003 & 2008 :
Prevalence of Atherosclerosis- Related Risk Factors
& Diseases- Age Adjusted
Risk factors Prevalence
(C.I. ) in %
2003
Dyslipidemia 62.3 (60.5-64.0)
Smoking 35.9 (33.6-38.2)
Obesity by WHR ,M 12.0 (10.4-13.7)
Hypertension (Age-adjusted) 16.4 (10.8-18.0)
Obesity (BMI ≥ 30) 4.7 (1.6-7.7)
Overweight (BMI ≥ 25) 19.7
Diabetes by FPG and Hx 4.6 (2.2-7.0)
Obesity by WHR, F 53.0 (50.0-56.0)

2003 – Dans A, MoralesD, et al. Phil J Intern Med 2005;43:103-115.

2008 – SyR, MoralesD, et al. for publication - Journal of Epidemiology 2012