1 ..2551 Thai Hypertension Society: Guidelines in the Treatment of Hypertension 2008 Hypertension( ) 140/90. Isolatedsystolichypertension140. 90 .Isolated office hypertension (White coat hypertension) 140/90 . 135/85 . ( ) 1 (. ) 18 CategorySBPDBP optimal 110 Isolated systolic hypertension >14025 ./2 BMI >30 ./2 >90 . >80 . 4 1. 30 5 2 2. digital armcuff(bladder) 80 arm cuff 12-13 .x35 . 3.- arm cuff 2-3 . brachial artery- SBP (rubber bulb) brachial artery 2-3 ./ SBP - stethoscope brachial artery SBP 20-30 . (Korotkoff I) SBP (Korotkoff V) DBP- 2 1-2 + 5 . 2 5 . 3 + 5 . - 2 1 SBP SBP 20 . orthostatic hypotension orthostatic hypotension SBP SBP 5 (automatic blood pressure measurement device)1. ( )2. 3. 3 4. sphygmomanometer 5 . 135/85 . 5. isolated office hypertension 1.Fasting plasma glucose2.Serum total cholesterol, HDL-C, LDL-C, triglyceride3.Serum creatinine4.Serum uric acid5.Serum potassium6.Estimated creatinine clearance (Cockroft-Gault formula) estimated glomerular filtration rate (MDRD formula) 7.Hemoglobin hematocrit8.Urinalysis (dipstick test urine sediment)9.Electrocardiogram 1.Echocardiography 2.Carotid ultrasound carotid bruit3.Ankle brachial BP index4.Postload plasma glucose fasting plasma glucose 100-125 ./. 65.Microalbuminuria dipstick microscopic examination6. (home BP) 24 (24 hr ambulatory BP monitoring) 7. proteinuria urine protein/creatinine ratio dipstick8. fundoscopy 9. pulse wave velocity ( )1. 2. secondary hypertension renin, aldosterone, corticosteroid, catecholamines , arteriography, ultrasound CT MRI 2 1. total cardiovascular risk (organ damage) (established cardiovascular or renal disease)2. 1. SBP DBP ( 1-3)2. pulse pressure () >90 . 3.>55 / >65 4.5. total cholesterol >190 ./. LDL-C >115 ./. HDL-C 90 . >80 . (Organ damage-OD)1. left ventricular hypertrophy (LVH) (Sokolow-Lyon >38 mm; Cornell >2440 mm.ms) strain pattern ventricular overload, , (heart block) 2.Echocardiography LVH (LVMI >125 /2, >110 /2) 3.Carotid wall thickness (IMT >0.9 .) plaque 4.Carotid-femoral pulse wave velocity >12 ./5.Ankle/brachial BP index 126 ./. 2.Postload plasma glucose >198 ./. (established cardiovascular and renal disease) 1.-Ischemic stroke-Cerebral hemorrhage -Transient ischemic attack (TIA) 82.-Myocardial infarction-Angina pectoris-Coronary revascularization-Congestive heart failure3. -Diabetic nephropathy-: plasma creatinine >1.5 ./., >1.4 ./. -Albuminuria >300 ./ proteinuria >500 ./4. 5. -Hemorrhage -Exudates -Papilledema - - ( 2) 9 2 SBP (Body mass index) = 18.5-24.9 ./.. 5-20 . 10 . DASH diet (Dietary Approach to Stop Hypertension) 8-14 . 100 mmol (2.4 6 ) 2-8 . aerobic ( 30 ) 4-9 . 2 drinks/ (ethanol 30 / 720 ., 300 . , 90 .) 1 drink/ 2-4 . 10 10 ( 3) 3 10 (.) (SBP 120-129 DBP 80-84) high normal (SBP 130-139 DBP 85-89) 1 (SBP 140-159 DBP 90-99) 2 (SBP 160-179 DBP 100-109) 3 (SBP >180 DBP >110) 1. 2. 1-2 3. 3 MS OD 4. MS - metabolic syndrome, OD - organ damage 10 140/90 . BP >130/80 . CKD / BP >140/90 .* BP 130/80 . CKD ** BP 20/10 . 2 4. DiureticsAngiotensinreceptor antagonistsCalcium antagonists-blocker-blockerACE inhibitors 5 () () () CCBs dihydropyridine -blockers 135. ( 4) 4 Thiazide diureticsCalcium antagonists (non-dihydropyridines) Isolated systolic hypertension (elderly)Angina pectoris Heart failureCarotid atherosclerosisHypertension in blacksSupraventricular tachycardia Loop diuretics ACE inhibitors End stage renal diseaseHeart failure Heart failureLV dysfunction Post-myocardial infarction Diuretics (antialdosterone)Diabetic nephropathy Heart failureNon-diabetic nephropathyPost-myocardial infarctionLV hypertrophy Carotid atherosclerosis Beta-blockersProteinuria/Microalbuminuria Angina pectorisAtrial fibrillationPost-myocardial infarctionMetabolic syndromeHeart failure TachyarrhythmiasAngiotensin receptor blockersGlaucomaHeart failure PregnancyPost-myocardial infarction Diabetic nephropathy Calcium antagonists (dihydropyridines)Proteinuria/MicroalbuminuriaIsolated systolic hypertension (elderly) LV hypertrophy Angina pectorisAtrial fibrillation LV hypertrophyMetabolic syndrome Carotid/Coronary AtherosclerosisACE inhibitor-induced cough Pregnancy 14 ACE inhibitors angiotensin receptor blockers 5. ( 5) 5 -blockersCHF ACE inhibitors,ARBsPregnancyBilateral renal artery stenosisHyperkalemia ClonidineMethyldopa Withdrawal syndromeHepatotoxicity-blocker A-V (grade 2 3) block Asthma Obstructive airway diseasePeripheral artery diseaseReserpine DepressionActive peptic ulcer Diuretic Gout CCBscongestive heart failure isolated office hypertension OD OD 15 ( 6) 6 (.) SBPDBP 110 1 1 1. 2. 3. , e-mail 4. 5.6. 7. 8. 169. 10. 11. 12.

1.World Health Organization, International Society of Hypertension Writing Group. 2003 WorldHealth Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. J Hypertens 2003;21:1983-1992. 2.The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). 2007 Guidelines for the Management of Arterial Hypertension. J Hypertens 2007;25:1105-1187. 3.The JNC 7 Report. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. JAMA 2003;289:2560-2572. 4.Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. Arch Intern Med 1997;157:2413-2446. _______________________________________ 19/1/2551