We may not realize it, but Filipinos are dying weekly at a rate similar to five fully loaded jumbo commercial jets crashing every week—that’s around 260 major jet crashes every year, with not a single passenger surviving.

I’m sure that even if we had only one fully loaded commercial jet crashing every year in the country for the last five years, all of us would be seriously alarmed, and the government would exert all efforts to make sure it won’t happen again.

But in the case of hypertension, it has likely killed more than a million of our countrymen since the turn of the century, but the only intense reaction we could elicit whenever we raise the alarm is an incredulous look, which seems to say, “It can’t be that bad.”

Last week, I used this plane-crash metaphor when I co-chaired and spoke in the Experts Convergence and Health Outcomes (Echo) conference in Manila, and the Asia Pacific Cardio-Hypertension Summit in Singapore. Hopefully it made our medical colleagues rethink the current state of affairs in fighting the battle against high blood pressure (BP).

It can’t be business as usual in implementing the same old algorithms in managing high BP. We have to address it with more intensity and effectivity, assessing where we’re falling short.

Uncontrolled high BP remains the leading cause of deaths worldwide, accounting for more than 10 million deaths annually. But I can’t help but get the impression it’s not given the urgent attention it deserves here and abroad.

I describe it as the elephant in the room. It’s making a lot of noise and destroying a lot of things, yet we don’t seem to mind it. It’s so big so we can’t say we can’t see it. But in colloquial language—dedma lang.

There is simply an inexplicable inertia to do what needs to be done to control hypertension. True, our awareness and treatment rates in people with high BP have gone up since the ’80s. Around eight out of 10 hypertensives are now aware they have elevated BP, and six out of 10 are getting some form of treatment. But only a third of those under treatment are actually controlled.

Inertia

The inertia is on all sides—physician, patient and healthcare system. Many physicians still treat high BP like it’s a mild case of the flu. They prescribe medicines, but in up to four out of five cases, they don’t escalate or adjust the dose of treatment if the BP remains uncontrolled.

Many doctors still seem to think that so long as they’ve prescribed an antihypertensive pill, they’ve done their part. They don’t even bother to check on the lifestyle of their hypertensive patients. What kind of food do they eat? Do they smoke, drink alcohol excessively? How do they handle stress?

On the patients’ side, inertia is manifested as poor compliance to treatment. They don’t religiously follow their doctor’s instructions, especially if multiple pills are prescribed, the medicines are expensive, and they have intolerable side effects.

The average elderly person takes around eight to 12 pills daily since they have a number of medical issues that need maintenance medicines. Unless they are strongly motivated by their physicians to comply in taking all these medicines, adherence to treatment is likely going to suffer.

Doctors must realize the seriousness of an issue like patient compliance. The problem is, most doctors don’t even check on this and they just presume their patients are complying with all their instructions. Nothing can be farther from the truth.

On the other hand, patients also can’t accurately assess how compliant they have been in the last several months.

Hence, both physician and patient must always have physician inertia and poor patient compliance at the back of their mind as the likely culprit—when the BP remains uncontrolled and the patient starts developing hypertension-related complications.

This problem is the rampaging big elephant in the room, and the sooner we address it intently, the better our chances of not getting killed by it.