Somkiat Sangwatanaroj

Prevalence and management of prehypertension and hypertension by geographic regions of Thailand: the Third National Health Examination Survey, 2004.

Objective To determine the prevalence of prehypertension and hypertension, and management of hypertension, by geographic regions of Thailand. Methods Using a stratified, multistage sampling design, data from a nationally representative sample of 39 290 individuals aged ≥ 15 years were collected by interview, physical examination and blood sample. Results The prevalence of hypertension and prehypertension weighted to the national 2004 population was 22.0% [95% confidence interval (CI) = 20.5–23.6] and 32.8% (95% CI = 31.5–34.1), respectively, with a higher prevalence in men compared to women. Hypertension was more common in urban compared to rural men, but similar between urban and rural women. Despite some variation, the prevalence of hypertension and prehypertension was relatively uniform across geographical regions. Of those identified as having hypertension in the survey, 69.8% (95% CI = 67.8–71.7) were unaware that they had hypertension. Although the majority of those who were aware (78.2%; 95% CI = 75.8–80.5) had taken blood pressure-lowering drugs in the last 2 weeks, of these only 36.6% (95% CI = 33.3–40.0) had blood pressure < 140/90 mmHg. Rural populations and those from the economically poorer Northeast region were more likely to be unaware that they had hypertension. Conclusion Compared to previous surveys, the prevalence of hypertension and prehypertension is rising rapidly, and is spread relatively evenly across regions of Thailand. Levels of awareness of hypertension were low across the country. A challenging task remains in improving screening, treatment and control of hypertension at the same time as promoting healthier lifestyles.

Changes in prevalence, awareness, treatment and control of hypertension in Thai population, 2004-2009: Thai National Health Examination Survey III-IV.

Objective: To determine the changes in prevalence, awareness, treatment and control of hypertension and their metabolic risk factors in Thai population between 2004 and 2009. Methods: The Thai National Health Examination Survey (NHES) in 2004 and 2009 data were used. Blood pressure and anthropometric measurements were performed. Prevalence, awareness, treatment and control of hypertension of Thai population aged at least 15 years were calculated. Analyses were weighted to the probability of sampling. Results: The prevalence of hypertension in 2004 and 2009 were relatively stable at approximately 21.0%. There was improvement in awareness of hypertension, from 18.2% for men and 33.0% for women in 2004 to 39.5 and 59.4% in 2009, respectively. The high blood pressure control rates improved from 4.8 to 14.4% for men and from 10.8 to 27.2% for women, respectively (all P < 0.05). The improvement in awareness, treatment and control of hypertension was also observed in individuals with diabetes, obesity and hypercholesterolemia. However, among hypertensive individuals, there were increases in proportions of obesity (BMI ≥ 25 kg/m2) between two surveys: from 39.1 to 47.5% in men and from 54.6 to 62.9% in women, respectively (all P < 0.05). Conclusion: Despite improvement in awareness and control of hypertension in Thai population, a large proportion of hypertensive individuals remained suboptimally controlled. Strengthening measures to control high blood pressure and metabolic risk factors, especially obesity and hypercholesterolemia, in individuals with hypertension are needed.

Increased alanine aminotransferase level and future risk of type 2 diabetes and impaired fasting glucose among the employees in a university hospital in Thailand

AIM The purpose of this study was to determine the association between baseline alanine aminotransferase (ALT) levels, and future risk of impaired fasting glucose and type 2 diabetes among the employees of a university hospital in Bangkok, Thailand. METHODS Totally, 2370 and 1619 workers without diabetes and impaired fasting glucose (IFG) at baseline, respectively, who were 35 years or older were followed during 2001-2005. Diagnosis of IFG and type 2 diabetes was based on the fasting plasma glucose levels of 100-125 and greater or equal to 126 mg/dl, respectively. RESULTS Higher baseline ALT levels were associated with future diabetes risk in an obvious dose-response manner (the OR [95% CI] for the groups with baseline ALT of 17-22, 23-38, and greater than 38 mg/dl comparing to the group with baseline ALT of 1-16 mg/dl were 4.75 [1.25-18.10], 6.14 [1.54-24.45], and 7.19 [1.32-39.16], respectively). Magnitude of association were even higher among those with existing IFG at baseline. The association patterns were consistent for both genders. Concerning the IFG risk, while those who developed IFG had significantly higher baseline ALT levels than those who remained normal at the end of follow-up period, further analyses did not show that baseline ALT was significantly associated with future IFG risk. CONCLUSION Present study provided supporting evidence from a cohort of Asian subjects about the ALT and future type 2 diabetes risk.

Microalbuminuria and metabolic risk factors in patients with type 2 diabetes in primary care setting in Thailand.

OBJECTIVE To determine the prevalence of microalbuminuria and associated risk factors in patients with type 2 diabetes in primary care. METHODS Clinical information of diabetic patients in 70 primary care units in Thailand was collected in a cross-sectional survey. Multinomial logistic regression model was used to examine several clinical risk factors with microalbuminuria and macroalbuminuria. RESULTS A total of 4162 patients were included. The prevalence of microalbuminuria was 39.12% and macroalbumninuria was 7.83%. The proportion of patients with HbA1c<7% was 37.9%. Independent risk factors for microalbuminuria and macroalbuminuria included HbA1c (adjusted OR 1.54, 95%CI 1.30-1.83 and 2.06, 95%CI 1.49-2.84 per unit increase in HbA1c, respectively), triglyceride >/=1.7mmol/L (1.31, 1.11-1.56 and 1.44, 1.06-1.98), hypertension (1.31, 1.10-1.54 and 1.64, 1.23-2.20), and duration of diabetes >/=5 years (1.31, 1.11-1.55 and 2.39, 1.74-3.28). Metabolic syndrome was associated with macroalbuminuria (OR 1.36, 95%CI 1.01-1.84). CONCLUSION The high prevalence of microabuminuria and suboptimal glycemic control for the diabetic patients were found to highlight the need to improve in control of glycemia and metabolic risk factors.

Prevalence of Dyslipidemia and Management in the Thai Population, National Health Examination Survey IV, 2009

This study determined the prevalence and management of dyslipidemia in Thai adults using data from the Thai National Health Examination Survey IV in 2009. Dyslipidemia was defined based on the Third Adult Treatment Panel guidelines. A total of 19,021 adults aged 20 yr and over were included. Mean (SE) levels of total cholesterol, HDL-C, LDL-C, and triglycerides were 206.4 (1.03), 46.9 (0.34), 128.7 (1.09), and 131.4 (2.20) mg/dL, respectively. Prevalence of high LDL-C, low HDL-C, and high triglycerides were 29.6 %, 47.1 %, and 38.6%, respectively. Compared with individuals in the north and northeast, residents in Bangkok and Central region had significant higher levels of LDL-C but lower level of HDL-C. Triglyceride level was the highest in the northeast residents. Overall, 66.5% of Thais had some forms of dyslipidemia. Awareness and treatment of high LDL-C among those with high LDL-C were 17.8% and 11.7%, respectively. Among individuals aware of high LDL-C, those at highest CHD risk compared with those at low risk had higher percentage of treatment (73.1% versus 51.7%, resp.) but lower percentage of control at goal (32.9% versus 76.4%, resp.). Various forms of dyslipidemia are common in Thai adults, with a low level of awareness and treatment of high LDL-C.

Effectiveness of coronary heart disease risk factors reduction program for hypertensive patients in Thailand

Background: Currently, “multiple risk factor reduction program” for coronary heart disease (CHD) risk is proposed in Thailand, but there is little information about its effectiveness for Thai hypertensive patients. Objectives: To investigate the effectiveness of the CHD risk program among hypertensive patients in Thai community hospitals. Material and methods: Seven hundred eighty one hypertensive patients (aged 35-64 years) were selected from four hospitals in Sisaket, Thailand between Sept 2007 and Aug 2008. The intervention program included: a) provide training about the overview of CHD and global risk assessment, and b) patient training about risk factor modification skill. The control subjects received health education and usual care. The program effectiveness was evaluated using changes in the RAMA-EGAT heart score and risk factors, such high density lipoprotein cholesterol or serum total cholesterol, one year after the program implementation. Data analysis was conducted using “t”-test for the pre-post difference between the intervention and control groups. Results: The changes in the RAMA-EGAT heart score were -0.03 vs +0.09 for the intervention and control groups, respectively. Changes in high density lipoprotein cholesterol, waist circumference, systolic, diastolic, and serum total cholesterol were statistically significant between for the both groups. The CHD knowledge was improved significantly between the both groups, but the smoking quit-rate was not significantly different. There was a significant association of intervention with the improvement in knowledge score, HDL-C, and waist circumference, but blood pressure and serum total cholesterol levels in the control were reduced greater than those in the intervention groups. Conclusion: This program did not sufficiently reduce the change global risk score, but some risk factors were improved significantly. The global risk assessment should be integrated with behavior counseling and treatment activity for hypertensive patients.

Enhanced happiness and stress alleviation upon insight meditation retreat: mindfulness, a part of traditional Buddhist meditation

ABSTRACT This research aims to examine how traditional insight meditation in Thailand is trained and to investigate the impact of this practice on happiness and perceived stress. The fuller meaning of mindfulness and how to interweave mindfulness in daily practice is discussed. The intervention was a seven-day traditional insight meditation retreat in Thailand. The final sample included 656 participants, n = 330 and 326 in experimental group and control group, respectively. Validated versions of happiness and perceived stress scales for Thai people were used. The magnitude of happiness and stress changes following the intervention, determined by effect sizes were used as a benchmark for interpreting the health status change between baseline and post-test. The effect sizes for happiness and perceived stress were .379 and −.428 in the meditation group, which is much greater, compared to the effect sizes of −.045 and −.003, respectively, in the control group.