Trends in Cardiovascular Disease Risk Factors and Predicted 10-Year Risk Among Individuals with Hypertension in Thailand: A Nationwide Study, 2011–2018

Cardiovascular disease (CVD) remains a leading cause of mortality in Thailand. We evaluated trends in CVD risk-factor profiles and predicted 10-year CVD risk among individuals receiving outpatient hypertension care under the Universal Health Coverage framework to inform national prevention strategies and guide risk-stratification policies. We conducted a repeated cross-sectional study using nationwide data from the Thailand DM/HT study (2011–2018), including 226,420 adults with hypertension. Ten-year predicted CVD risk was estimated using the 2019 World Health Organization Southeast Asia region-specific scores (laboratory-based [n = 123,042] and non-laboratory-based [n = 143,025] models). Concordance was evaluated among 119,134 participants. Counterfactual simulations estimated the potential impact of optimizing modifiable risk factors. Between 2011 and 2018, smoking and hyperlipidemia prevalences declined, whereas obesity (body mass index ≥ 25 kg/m 2 ) increased from 44.9% to 48.1% (overall absolute change: + 3.2 percentage points, 95% confidence interval [CI]: 2.0–4.3). Uncontrolled hypertension under standard targets (blood pressure [BP] ≥ 140/90 mmHg) remained stable (34.8% in 2011 versus 33.2% in 2018). However, it increased significantly under stricter optimal targets (≥ 130/80 mmHg for ages 20–64 and ≥ 140/80 mmHg for ages ≥ 65) from 59.7% to 62.6% (overall absolute change: + 2.9 percentage points, 95% CI: 1.4–4.5). Mean predicted 10-year CVD risk was stable in the non-laboratory-based model (7.8% in 2011 versus 7.9% in 2018; high-risk [ ≥ 20%] prevalence: 1.6% versus 1.5%) and slightly decreased in the laboratory-based model (8.3% vs. 8.0%; high-risk prevalence: 3.1% versus 2.5%). Both models demonstrated strong correlation (Pearson’s r = 0.90) and substantial agreement (78.0%, kappa = 0.67). Counterfactual simulations showed that simultaneously optimizing BP, total cholesterol, smoking, and diabetes could reduce the prevalence of moderate-to-very high CVD risk (≥ 10%) by 27.4%, primarily driven by BP lowering. Between 2011 and 2018, several CVD risk factors among Thai adults with hypertension improved. However, gains were attenuated by rising obesity and suboptimal BP control. Simulation models suggest that hypothetically optimizing modifiable factors—particularly BP—could substantially lower predicted 10-year CVD risk. These observational findings support policy initiatives aimed at stricter BP targets, obesity management, and the deployment of non-laboratory risk assessment tools in resource-limited settings.