The undiagnosed crisis

When the Iloilo Provincial Health Office warned this week of a sharp rise in stroke cases across Western Visayas, it offered a familiar explanation: patients are not taking their maintenance medicine, and too many of us live unhealthy lives. Both observations are true. Neither is the heart of the matter.

The harder truth sits in a single line of the PHO’s own statement. Many people who suffer strokes, provincial health officer Dr. Maria Socorro Colmenares Quiñon noted, “remain unaware they already have hypertension.” That is not a story about non-compliance. You cannot fail to take medication for a disease no one has told you that you have. It is a story about a health system that is not finding sick people until they arrive at the emergency room.

The scale of the gap is national, well-documented, and damning. The PRESYON-4 survey, the country’s most recent large-scale look at hypertension, found that adult prevalence climbed from 22 percent in the 1990s to 37 percent by 2021 — and that only 52 percent of those with high blood pressure were aware of their condition. Barely a third had it under control. A 2025 study of low-income Filipino households, part of the international RESPOND research, found that more than a quarter of hypertensive adults were undiagnosed, that only one in four of them obtained a diagnosis even a full year later, and that the odds of going undetected were highest for those living in rural areas. Western Visayas, with its wide rural hinterland, sits squarely in that blind spot.

This is the context for the figures now alarming our hospitals. WVMC specialists, cited by Dr. Quiñon, reported 808 stroke cases in 2024 and 2,326 in 2025 — a near-tripling. That number deserves scrutiny before it hardens into received fact; a jump that steep in twelve months may reflect changes in how cases are counted, referred, or recorded as much as a true surge in disease. But even the cautious reading is bleak. High blood pressure is the leading risk factor for stroke, the second-deadliest condition in the country, and a province where half its hypertensives are walking around undiagnosed is a province manufacturing future stroke patients.

Dr. Quiñon is right that prevention works, and right to urge daily medication, healthier diets, and screening for everyone 20 and older. But notice what that last appeal concedes. If the answer is to screen the entire adult population, then the honest admission is that we are not screening it now. The question the public deserves answered is not whether Ilonggos should get their blood pressure checked. It is why the system has not been checking them.

Those answers are uncomfortable and specific. Research on Philippine primary care has repeatedly identified the same operational failures: rural health units that are understaffed, maintenance medicines that run short, and the simple cost of transport that keeps a farmer or fisher from a clinic visit that would have caught the problem early. PhilHealth’s primary-care package nominally includes blood pressure measurement and common antihypertensives such as amlodipine and losartan. Whether those drugs are actually, reliably, and freely on the shelf at every barangay health station in Iloilo province is a question the PHO can answer — and should.

Because the alternative is a slow, expensive catastrophe. Even after PhilHealth raised its stroke benefit in 2023, the package — ₱76,000 for ischemic stroke, ₱80,000 for hemorrhagic — covers only a sliver of acute care that can run past a million pesos, and there is no dedicated benefit for the months or years of rehabilitation that follow. A blood pressure cuff at a rural health unit and a free month of losartan cost almost nothing by comparison. The cheapest possible moment to stop a stroke is years before it happens, in a clinic, with a diagnosis.

We welcome the PHO’s candor in raising the alarm. We simply urge that the alarm point in the right direction. Telling hypertensive patients to take their pills is sound advice that will help the people already diagnosed. It does nothing for the larger, quieter population that has never been tested — and it is from that population that the next 2,326 cases will come.

The provincial government should treat universal hypertension screening not as a slogan but as a measurable target: clinics staffed, medicines stocked, results tracked. Anything less leaves the burden where it has always fallen — on Ilonggo families, in hospital corridors, paying for a disease the system had every chance to catch.