Burden, determinants and control of hypertension: a Bhutanese perspective

In its 60 years of pursuing modern developmental goals, Bhutan has done remarkably well. However, the country now faces a triple burden of diseases – communicable diseases, noncommunicable diseases, and accidents and injuries. Among the risk factors for noncommunicable diseases, hypertension is perhaps the most important cause of an increasing number of strokes, heart attacks and chronic kidney diseases in Bhutanese adults. Unfortunately, the proportion of those with hypertension on treatment is small and the proportion of those with both diabetes and hypertension is large. Another unhealthy sign is the large proportion of overweight adults, which is the main driver of noncommunicable diseases, symbolized by a moderately high prevalence of diabetes mellitus. A diet that is high in carbohydrates, fats and salt, in addition to the unhealthy but socially acceptable custom of alcohol use, are responsible for this alarming trend. Increasing consumerism in society has led to a rise in sedentary lifestyles and further increase in salt and fat intake from imported food items. All this does not bode well for the health of the Bhutanese. Comprehensive policies and strategies at both the population and individual levels are needed to meet the challenge posed by the triple burden of diseases. In resource-poor Bhutan, implementation of the World Health Organization (WHO) “best buys” and effective scaling up of the WHO Package of Essential NCD Interventions to all districts holds promise. A robust combined response from both the government and all of society would be needed to overcome these challenges.