Thai Guidelines

on The Treatment
of Hypertension

2558


Thai Guidelines on The Treatment of Hypertension 2012
Update 2015




40
65




80


1
2










.. 2555
6 6








( ) .. 2558

1. . .
2. . .
3. .
4. . .
5. .. .
6. . .
7. . .

1. . .
2. . .
3. . .
4. .
5. . .
6. . .
7. .
8. . .
9. .. .
10. . .

 (Strength of Recommendation)

++


+

+ -


-

- -

(Quality of Evidence)

I (systematic review)
randomized controlled clinical trial
II
non-randomized controlled clinical trial
cohort case-control
analysis

 III

IV


2

ABI ankle-brachial blood pressure index
ABPM ambulatory blood pressure monitoring
ABs alpha-blockers
ACCORD The Action to Control Cardiovascular Risk in Diabetes
ACEIs angiotensin converting enzyme inhibitors
ACS acute coronary syndrome
ARBs angiotensin II receptor blockers
AV atrioventricular
BBs beta blockers
BMI body mass index
BP blood pressure
BW body weight
CAD coronary artery disease
CCBs calcium channel blockers
CKD chronic kidney disease
CKD-EPI chronic kidney disease-epidemiology collaboration
CT computerized tomography
CVD cardiovascular disease
DASH The Dietary Approaches to Stop Hypertension
DBP diastolic blood pressure
DHP CCBs dihydropyridine calcium channel blockers
DRI direct renin inhibitor
ECG electrocardiography
eGFR estimated glomerular filtration rate
FPG fasting plasma glucose

GFR glomerular filtration rate
HBPM home blood pressure monitoring
HDL-C high-density lipoprotein cholesterol
HT hypertension
ISH isolated systolic hypertension
LDL-C low-density lipoprotein cholesterol
LVH left ventricular hypertrophy
MH masked hypertension
MRAs mineralocorticoid receptor antagonists
MRI magnetic resonance imaging
non-DHP CCBs non-dihydropyridine calcium channel blockers
NSAIDs non-steroidal anti-inflammatory drugs
NSTEMI non-ST-segment elevation myocardial infarction
OGTT oral glucose tolerance test
OSA obstructive sleep apnea
PMI point of maximal impulse
PWV pulse wave velocity
RAAS renin-angiotensin-aldosterone system
RF risk factor
SBP systolic blood pressure
SCr serum creatinine
STEMI ST-segment elevation myocardial infarction
TIA transient ischemic attack
TOD target organ damage
t-PA tissue plasminogen activator
WC waist circumference
WCH white-coat hypertension



(Guidelines on the treatment of hypertension)

1

1.1
(hypertension) (systolic blood
pressure, SBP) > 140 . / (diastolic blood pressure,
DBP) > 90 .
Isolated systolic hypertension (ISH) SBP > 140 . DBP <
90 .
Isolated office hypertension white-coat hypertension (WCH)
(SBP > 140 ./
DBP > 90 .)
(SBP < 135 . DBP < 85 .)
Masked hypertension (MH)
(SBP < 140 . DBP < 90 .)
(SBP > 135 . /
DBP > 85 .)

1.2

1
 1.2.1
30
5 2

1.2.2
(mercury sphygmomanometer)
(automatic blood pressure measurement device)
arm cuff
(bladder) 80
27-34 . arm cuff 16 . x 30 .
1.2.3
(non-dominant arm) arm cuff
2-3 .
brachial
SBP (rubber bulb)
brachial
2-3 ./ SBP
bell diaphragm stethoscope
brachial SBP 20-30 .
(Korotkoff sound phase I) SBP
(Korotkoff sound phase V) DBP
2 1

5 . 1-2 ( +/ II)
( +/
II) 20/10 .

2
 10
SBP > 10 .


2 1 3 ( +/
II)
SBP SBP 20 .
orthostatic hypotension SBP SBP

1.3

1

1 18

Category SBP DBP

(.) (.)
Optimal < 120 < 80
Normal 120-129 / 80/84
High normal 130-139 / 85-89
Grade 1 hypertension (mild) 140-159 / 90-99
Grade 2 hypertension (moderate) 160-179 / 100-109
Grate 3 hypertension (severe) > 180 / > 110
Isolated systolic hypertension (ISH) > 140 < 90
: SBP = systolic blood pressure; DBP = diastolic blood pressure.
SBP DBP ISH
SBP

3
1.4 (self
home blood pressure monitoring, HBPM)
1.4.1 isolated office hypertension WCH MH
1.4.2

1.4.3 ( 1.2.1 1.2.2)
1.4.4

1.4.5

1.4.6

1.4.7 2
2 2 ( 4 ) 3-7


1.4.8
5 . SBP > 135 .
/ DBP > 85 .
1.4.9
1.4.10

1.5 (ambulatory blood

pressure monitoring, ABPM)
1.5.1 ABPM

4
 1.5.2 ABPM target organ damage (TOD) HBPM

1.5.3 ABPM HBPM
(BP variability)

1.6
1.6.1 > 140/90 . 2
HBPM ( +/
II)
1.6.2 TOD
( ++/ II)
1.6.3 TOD
(left ventricular hypertrophy, LVH), (chronic kidney disease, CKD)
(hypertensive retinopathy)
(cardiovascular disease, CVD) ( +/ II)
1.6.4 TOD LVH, albuminuria
proteinuria TOD ( +/ II)
1.6.5
140/90 .
( +/ II)
1.6.6

1.6.6.1 Accelerated malignant hypertension
> 180/110 . (retinal hemorrhage) /
(papilledema) ( +/ II)
1.6.6.2 Pheochromocytoma
labile postural hypotension ( +/ II)
1.6.7
(secondary hypertension) ( +/ II)

5
 2

4
1.
2. TOD LVH, hypertensive retinopathy,
(microalbuminuria) (macroalbuminuria)
3. CVD CKD
CVD 10
4.
CVD

1. CVD
(dyslipidemia)
2. TOD
3. CVD

4. CVD CKD


CVD statins

2.1

2.1.1

6
 beta-blockers (BBs)

2.1.2
(primary hypertension)
CVD ( 55 65 )
2.1.3

(obstructive sleep apnea, OSA)
( type A)
2.1.4 TOD

(intermittent claudication)
2.1.5

pheochromocytoma primary aldosteronism
2
, cocaine, amphetamine, steroids, non-steroidal anti inflammatory drugs (NSAIDs),
pseudoephedrine
2.1.6

2.2

2.2.1
( 1)
2.2.2 TOD CVD ( 2)

7
 2 target organ damage cardiovascular disease

TOD
LVH PMI
S4 gallop
Atrial fibrillation*
S3 gallop, pulmonary rales,

(facial palsy),
(hemiparesis/hemiplegia),
(hemihypoesthesia/hemianesthesia),
(dementia)
Retinopathy
(exudates), (hemorrhage),
(papilledema)

-
(atherosclerosis) carotid (carotid bruit)
TOD = target organ damage; PMI = point of maximal impulse; LVH = left ventricular hypertrophy.
* Atrial fibrillation
TOD

2.2.3 ( 3)

8
 3

2 Polycystic kidney disease
Takayasus disease
2 Coarctation of aorta
murmur precordium
Renal artery stenosis

Caf au lait spot (neurofibroma) Pheochromocytoma

Primary aldosteronism
(hemangioma) Von Hippel-Lindau disease
cerebellum
Chronic kidney disease
(truncal obesity) Cushings syndrome
(purplish striae)

2.2.4 (abdominal obesity)

(body mass index, BMI) BMI > 23 ./.2
BMI > 25 ./.2 ()
(waist circumference, WC) > 90 . > 80 . (
)

. (.)
: BMI =
(.)2

9
2.3
2.3.1

2.3.1.1 Fasting plasma glucose (FPG)

2.3.1.2 Serum total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-
density lipo-protein cholesterol (LDL-C), fasting serum triglyceride
12 fasting serum triglyceride
2.3.1.3 Serum electrolytes, serum creatinine (SCr) estimated
glomerular filtration rate (eGFR) ( Chronic Kidney Disease-Epidemiology Collaboration
[CKD-EPI]) ( 4)
2.3.1.4 Hemoglobin hematocrit
2.3.1.5 Urinalysis (dipstick test urine sediment)
2.3.1.6 Electrocardiography (ECG)

4 eGFR CKD-EPI

serum creatinine (./.) Equations

< 0.7 eGFR = 144 x (SCr/0.7)-0.329 x (0.993)Age

> 0.7 eGFR = 144 x (SCr/0.7)-1.209 x (0.993)Age
< 0.9 eGFR = 141 x (SCr/0.9)-0.411 x (0.993)Age

> 0.9 eGFR = 141 x (SCr/0.9)-1.209 x (0.993)Age
( Web-based http://www.kidney.org/professionals/KDOQI/gfr_calculator download eGFR
calculator mobile phone application Apple App Store).
eGFR = estimated glomerular filtration rate; SCr = serum creatinine.

2.3.2 CVD

2.3.2.1 Echocardiography

10
 2.3.2.2 Carotid ultrasonography
2.3.2.3 Ankle-brachial blood pressure index (ABI) pulse wave velocity (PWV)
2.3.2.4 Oral glucose tolerance test (OGTT) FPG > 100 ./.
2.3.2.5 albuminuria proteinuria urine albumin
(protein)/ creatinine ratio
2.3.2.6 HBPM ABPM
2.3.2.7 (fundoscopy)

2.3.3
2.3.3.1


2.3.3.2
renin, aldosterone,
corticosteroids, catecholamines ultrasonography
renal angiography computerized tomography (CT) magnetic resonance imaging
(MRI)

2.4
2.4.1 SBP DBP
2.4.2 pulse pressure > 60 .
2.4.3 > 55 > 65
2.4.4
2.4.5 total cholesterol > 200 ./., LDL-C > 130 ./.,
HDL-C < 40 ./. < 50 ./. triglyceride > 150 ./.
2.4.6 FPG 100-125 ./.
2.4.7 OGTT
2.4.8 CVD
2.4.9 WC > 90 . > 80 .

11
2.5 (sub-
clinical TOD)
CVD
( +/ II)
2.5.1 Electrocardiography LVH (Sokolow-Lyon voltage criteria SV1 +
RV5 RV6 > 3.5 mV, Cornell voltage criteria SV3 + RaVL > 2.8 mV
> 2.0 mV Cornell product Cornell voltage QRS width > 244 mV-msec)
2.5.2 Echocardiography LVH (left ventricular mass index > 115 /.2
> 95 /.2 )
2.5.3 Carotid wall thickness (intima-media thickness > 0.9 .) arterial plaque
2.5.4 Carotid-femoral PWV > 10 ./
2.5.5 ABI < 0.9
2.5.6 SCr (1.3-1.5 ./. 1.2-1.4 ./. )
2.5.7 eGFR < 60 .//1.73 .2 ( CKD-EPI)
2.5.8 albuminuria (urine albumin/creatinine ratio 30-300 ./
)

2.6
4
2.6.1
> 200 ./.
2.6.2 FPG > 126 ./.
2.6.3 2 OGTT > 200 ./.
2.6.4 hemoglobin A1c > 6.5%
(NGSP certified and standardized to DCCT assay)

12
2.7
2.7.1
2.7.1.1 Ischemic stroke
2.7.1.2 Cerebral hemorrhage
2.7.1.3 Transient ischemic attack (TIA)
2.7.2
2.7.2.1 Myocardial infarction
2.7.2.2 Angina
2.7.2.3 coronary revascularization
2.7.2.4
2.7.3
2.7.3.1 Diabetic nephropathy
2.7.3.2 CKD
2.7.3.3 Albuminuria > 300 ./ proteinuria > 500 ./
2.7.4
2.7.5
2.7.5.1 Hemorrhage
2.7.5.2 Exudates
2.7.5.3 Papilledema

2.8 10
CVD
CVD 10 ( ++/
I) ( 5)

13
 5 10

CVD ,
TOD , , CKD CVD

CVD 10 1,
CVD 1 5
CVD 5 10,
CVD 10

2.9 CVD
2.9.1
2.9.2 pulse pressure > 60 .
2.9.3
2.9.4 RF CVD > 3
2.9.5 TOD
2.9.6 CVD
2.9.7 CKD stage 3 (eGFR < 60 .//1.73 .2)

14
 3

3.1







6

BMI > 25 ./.2 BW 1 . SBP
1 . BW 10 .
SBP 5-20 .
DASH SBP 8-14 .
2,300 . SBP 2-8 .
SBP 4 .
DBP 2.5 .
SBP 2-4 .
BMI = body mass index; BW = body weight; SBP = systolic blood pressure; DASH = Dietary Approaches to Stop
Hypertension; DBP = diastolic blood pressure.

15

3.1.1 BMI
18.5-22.9 ./.2 WC 90 .
80 .
( ++/ II)
( +/ II)
5
1
3.1.2

30 5
10 3
(
++/ II)
CVD
(
) 5 2

3.1.2.1 50-70
( 220 )
(self-talk test) 150


3.1.2.2 70-85
75 10
30 3

16
 (qi gong) (tai chi)


(isometric exercise)

( / II)


7 ( +/ II)

. SBP > 180 . DBP > 110 .
.

.
.
.
.
.
3.1.3
2,300 ./
( ++/ I) () 1
(5 ) 2,000 . 1 350-500 . 1
320-455 . 1 492 .
3.1.4 DASH (Dietary Approaches to Stop Hyper-
tension) 5 ( 1 2
[1 ] 1 [1/2 ]) 4 ( 1
6-8 1 2-4
1 )
2-3 7

17
 , ,
( ++/ I)
/

( -/ II)


5
( ++/ II)
3.1.5
( ++/ IV)
1 (standard
drink) 2 ( ++/ IV)
1
10
3.1.5.1 35 2 30 .
3.1.5.2 40 30 .
3.1.5.3 10% 3 // 150 .
3.1.5.4 6% 4 // 200 .
3.1.5.5 5% : 240.
3.1.5.6 6.4% : 1/2 1/3
3.1.5.7 12% : 100 .
3.1.6

3-5

10

18

(Thailand National Quitline) 1600 Quitline 1600
1600 07.30-20.00 .

www.thailandquitline.or.th

3.2

CVD 10 ( 5) ( 7)
( ++/ I)

CVD ( ++/ I)
> 140/90 .
1
> 140/90 .
1 ) ( ++/ I)

19
 7

3.3
3.3.1 < 140/90 . ( ++/ I)
3.3.2 < 140-150/90 . 60 80
( ++/ I)
3.3.3 < 150/90 . > 80 ( ++/
I)
3.3.4 < 130/80 . < 50 ( +/
IV)
3.3.5 < 140/90 . ( ++/
I)
3.3.6 < 140/90 . CKD albuminuria
albuminuria 30 . ( ++/ II)

20
 3.3.7 < 130/80 . CKD albuminuria 30 .
( +/ III)
3.3.8 < 140/90 . CVD ( +/
II)

3.4
3.4.1 4
3.4.1.1 Thiazidetype diuretics
3.4.1.2 Calcium channel blockers (CCBs)
3.4.1.3 Angiotensin converting enzyme inhibitors (ACEIs)
3.4.1.4 Angiotensin receptor blockers (ARBs)
alphablockers (ABs) ( /
II) ABs
BBs ( / II) betablockers
(coronary artery disease,
CAD) acute coronary syndrome (ACS)
sympathetic ( BBs
bisoprolol, carvedilol, metoprolol succinate nebivolol
)
BBs ( 3.9.2 5.6.2)
( 5.6.2)
reninangiotensinaldosterone (RAAS blockers) direct renin inhibitor (DRI)

methyldopa, clonidine, reserpine
( +/ II)

3.4.2
( 8)
( +/ I)

21
 8

Asymptomatic organ damage
LVH ACEIs, CCBs, ARBs
Asymptomatic atherosclerosis CCBs, ACEIs
Albuminuria (30-300 ./) ACEIs, ARBs
Renal dysfunction ACEIs, ARBs
Cardiovascular disease
Previous stroke ACEIs, thiazide-type diuretics
Previous myocardial infarction BBs, ACEIs, ARBs
Angina pectoris BBs, CCBs
Heart failure Diuretics, BBs ( BBs
), ACEIs, ARBs, MRAs
Aortic aneurysm BBs
Atrial fibrillation, prevention ARBs, ACEIs, BBs MRAs
Atrial fibrillation, ventricular rate BBs, nonDHP CCBs
control
CKD/proteinuria (> 300 ./) ACEIs, ARBs
Peripheral artery disease ACEIs, CCBs

ISH (elderly) Diuretics, CCBs
Metabolic syndrome ACEIs, ARBs, CCBs
Diabetes mellitus ACEIs, ARBs
Methyldopa, BBs, CCBs
ACE = angiotensinconverting enzyme; ARBs = angiotensin receptor blockers; BBs = betablockers; BP = blood
pressure; ISH = isolated systolic hypertension; LVH = left ventricular hypertrophy; MRAs = mineralocorticoid
receptor antagonists; non-DHP CCBs = non-dihydropyridine calcium channel blockers; CKD = chronic kidney
disease; CCBs = calcium channel blockers.

22
 3.4.3
( 1)

/
cardiovascular risk cardiovascular risk

3 3

. Grade 1 hypertension (mild) Grade 2 hypertension

Cardiovascular risk 5
Cardiovascular risk 5
. 4 1
angiotensin converting enzyme inhibitors angiotensin receptor blockers

23
 2 2
( +/ II) ( 1) ACEIs
ARBs ( / II)

3.4.4
( 9)

24
 9

ACEIs, ARBs, - Diuretics -
DRI - 2 -

ABs -
- Clonidine -
> 5.5 / (withdrawal
- eGFR syndrome)
30 4 Methyldopa -
CCBs -
BBs - AV block (grade 2
3)
-
-
-

ACEIs = angiotensin converting enzyme inhibitors; ARBs = angiotensin receptor blockers; DRI = direct renin
inhibitor; ABs = alpha-blockers; eGFR = estimated glomerular filtration rate; BBs = beta blockers; AV =
atrioventricular; CCBs = calcium channel blocker.

3.5 Fixed-dose single-pill combinations

(fixed-
dose single-pill combination)

(improve adherence) ( +/
II) fixed-dose combination 2

25

3 fixed-dose combination
( RAAS CCBs diuretics)

3.6 white-coat hypertension masked hypertension

WCH
( +/ III)
WCH asymptomatic TOD
( +/ III)
white-coat effect
20/10 .
( +/
II)
MH
CVD
(true hypertension)
( +/ III)

3.7 isolated systolic hypertension (ISH)

3.7.1 diuretics DHP CCBs ( +/
II)
3.7.2 diuretics
DHP CCBs ( +/ II)
3.7.3 2
ABs, ACEIs, ARBs, BBs, central
acting drugs non-DHP CCBs ( +/ II)

26
3.8 Resistant hypertension
Resistant hypertension
140/90 . 3
diuretics resistant
hypertension 5-30
cardiovascular renal events
resistant hypertension
, white coat hypertension
( +/ II)


MRAs amiloride ABs doxazosin
( +/ II)
renal denervation baroreceptor stimulation
( +/ IV)

3.9
3.9.1 ( +/ II)
3.9.2 BBs
3.9.2.1 CAD ( ++/ I)
3.9.2.2 ( +/ II)
3.9.2.3 ( +/ II)
3.9.2.4 sympathetic ( +/
II)
3.9.2.5 ejection fraction
( +/ I)
3.9.3 BBs 2 DHP-CCBs
diuretics ( +/ II)

27
 3.9.4 DHP CCBs 2
diuretics ( +/ II)
3.9.5 diuretics 2 thiazide-type diuretics MRAs

1 ( +/ II)
3.9.6 MRAs ACEIs
ARBs eGFR < 60 .//1.73 .2
4.5 / ( +/ II) eGFR
2
( +/ II) 3-4
MRAs

28
 4

4.1
( 10)

10 ()

(.)
SBP DBP
< 140 < 90 1
140-159 90-99 2
160-179 100-109 1
> 180 > 110 1

4.2

1

4.3
4.3.1
4.3.2

29
 4.3.3 , e-mail

4.3.4
4.3.5
4.3.6
4.3.7
4.3.8
4.3.9
4.3.10

4.3.11

30
 5

5.1

SBP
SBP DBP
60 70 DBP


5.1.1
5.1.1.1 ( 1.2.3)
(variability) 50
WCH
white-coat effect


TOD

( ++/ II)

( +/ II)
5.1.1.2
>
140/90 .
60 80 < 140-150/90 .
> 80 < 150/90 .

31
 5.1.2

TOD

CVD ( ++/ I)
5.1.3
5.1.3.1 ( 3.1)
CVD ( ++/ I)
5.1.3.2
4 CCBs, thiazide type diuretics, ACEIs
ARBs CCBs
thiazide ACEIs ARBs
CCBs thiazide ACEIs ( ARBs)
(resistant hypertension)
( resistant hypertension)
alpha blockers doxazosin
(direct vasodilator) hydralazine
BBs

. Orthostatic hypotension ( 1.2.3)
baro-
receptor




orthotatic hypotension

white coat effect ( ++/ II)

32
 .


TOD ( ++/ I)

11

Diuretics BBs CCBs ACEIs ARBs MRAs ABs

thiazide

renal

AV block (grade 2 3)
non-DHP CCBs

: BBs = beta-blocker; CCBs = calcium channel blocker; ACEIs = angiotensin-converting enzyme
inhibitors; ARBs = angiotensin II receptor blockers; MRAs = Mineralocarticoid receptor antagonists; ABs = alpha-
blockers; non-DHP CCBs = non-dihydropyridine calcium channel blockers.
,

33
5.2 (coronary artery disease,
CAD)

(primary prevention)
(secondary prevention)
5.2.1

SBP < 140 stable angina, acute coronary syndrome
( +/ II)
SBP 130 .
SBP 115 . (
/ II)
DBP (coronary blood flow)
DBP (< 60 .)
( / III)
5.2.2

12

Stable CAD stable angina beta-blocker, ACEIs ARBs, thiazide-type
diuretics, CCBs nondihydropyridine
dihydropyridine
ACS unstable angina, NSTEMI, STEMI beta-blocker, ACEIs ARBs
beta-blocker, ACEIs ARBs MRAs
diuretics (thiazide-type loop diuretics)
: ACEIs = angiotensin-converting enzyme inhibitors; ARBs = angiotensin II receptor blockers; CCBs
= calcium channel blocker; CAD = coronary artery disease; ACS = acute coronary syndrome; MRAs =
mineralocorticoid receptor antagonists; NSTEMI = non-ST-segment elevation myocardial infarction; STEMI = ST-
segment elevation myocardial infarction

34
 beta-blocker
angina pectoris

beta-blocker ( +/ II) CCBs
stable angina ( +/ II)
non-DHP CCBs
( / II) DHP CCBs
nifedipine CAD ( /
II)

5.3
60






(aortic dissection)
(hypertensive encephalopathy)


5-10 2-3

5.3.1
5.3.1.1 72 2
. (tissue plasminogen
activator, t-PA) 4.5

35
 t-PA 185/110 .
nicardipine
2 . 1-2 5 ./.
2.5 ./. 10-15 labetalol
10 . 1-2
2-8 ./
t-PA 15 2
30 6 1 24
< 180/105 . 24


DBP > 140 . sodium nitroprusside
nifedipine

. t-PA SBP < 220 . DBP <
120 . 2-3
220/120 .
10-15
DBP < 110 . 30-60

120/80 .

180/110 .

36


5.3.1.2

140 90 .

(
++/ I)

( +/ II) ACEI
( +
I)



< 140/90 . ( +/ II)
(lacunar stroke) 130/80 .
( +/ II)
5.3.2
5.3.2.1



. SBP > 200 . mean arterial pressure > 150 .

5 ( +/ II)
. SBP > 180 . mean arterial pressure > 130 .

160/90 . 15

37
 ( +/ II) SBP 140 .
( +/ III)
5.3.2.2

5.4

5.4.1
> 115/75 .
CVD CVD

.. 2010
The Action to Control Cardiovascular Risk in Diabetes (ACCORD)
(SBP < 120 .)
(SBP < 140 .) 4.7
2 primary outcome
CVD,
, SCr
SBP
< 140/90 . ( ++/
I) < 130/80 .

( +/ II)

38
 5.4.2
ACEIs, ARBs CCBs CVD
ACEIs ARBs

( ++/
I) 1
ACEIs ARBs
ACEIs
ARBs ( ++/ I)

24
CVD
1

5.5
CKD
. 3
(glomerular filtration rate, GFR)
albuminuria
(urine albumin/creatinine ratio 30 ./ )


. eGFR 60 .//1.73 .2 3

39

CKD CKD

albuminuria
CKD albuminuria
()
CKD albuminuria
albuminuria ACEIs ARBs

CKD
5.5.1 CKD
< 30 . < 140/90 . ( ++/ II)
5.5.2 CKD
> 30 . < 130/80 . ( +/ III)
5.5.3 CKD 30-300 .
ACEIs ARBs ( +/ I
, + / III )
5.5.4 CKD > 300 .
ACEIs ARBs ( +/ I
, + +/ I )
5.5.5 ACEIs ARBs ( /
I)
5.5.6 CKD ACEIs ARBs
( ++/ II)
5.5.7 CKD ACEIs ARBs SCr, eGFR
14
SCr 30 4
5.5 / ( ++/ III)

40
 14 , eGFR
ACEIs ARBs

SBP (.) > 120 110-119 < 110
eGFR (.//1.73 .2) > 60 30-59 < 30
eGFR () < 15 15-30 > 30
(/) < 4.5 4.6-5.0 >5

4-12 2-4 < 2
BP 6-12 3-6 1-3

5.5.8 CKD 2
( ++/ II)
5.5.9 CKD
( 15)

15

% adjustment for GFR (ml/min)

Normal
> 50 10-50 < 10
Drug
each dose
freq. % each dose freq. % each dose freq. % each dose freq.
(mg)
Furosemide 20 300 q 12 24 h 100% q 12 24 h 100% q 12 24 h 100% q 12 24 h
HCTZ 6.25 200 q 24 h 100% q 24 h 100% q 24 h Ineffective
Indapamide 1.25 5 q 24 h 100% q 24 h 100% q 24 h Ineffective
Spironolactone 25 tid qid 100% q 6 12 h 100% q 12 24 h Avoid
Captopril 25 150 q 8 12 h 100% q 8 12 h 75% q 12 18 h 50% q 24 h
Enalapril 5 20 q 12 24 h 100% q 12 24 h 50 100% q 12 24 h 25% q 12 24 h
Ramipril 2.5 10 q 24 h 100% q 24 h 25 50% q 24 h 25% q 24 h
Lisinopril 5 40 q 24 h 100% q 24 h 50 75% q 24 h 25 50% q 24 h
Benazepril 10 40 q 12 24 h 100% q 12 24 h 50 75% q 12 24 h 25 50% q 12 24 h
Perindopril 28 q 24 h 100% q 24 h 2 mg q 24 48 h 2 mg q 48 h
Quinapril 10 40 q 12 24 h 100% q 12 24 h 12.5 5 mg q 24 h 25 mg q 24 h

41
 15

% adjustment for GFR (ml/min)

Normal
> 50 10-50 < 10
Drug
each dose
freq. % each dose freq. % each dose freq. % each dose freq.
(mg)
Losartan 25 100 q 24 h 100% q 24 h 100% q 24 h 100% q 24 h
Valsartan 80 320 q 24 h 100% q 24 h 100% q 24 h 100% q 24 h
Irbesartan 150 300 q 24 h 100% q 24 h 100% q 24 h 100% q 24 h
Telmisartan 20 80 q 24 h 100% q 24 h 100% q 24 h 100% q 24 h
Candesartan 8 32 q 24 h 100% q 24 h 100% q 24 h 100% q 24 h
Olmesartan 20 40 q 24 h 100% q 24 h 100% q 24 h 50% q 24 h
Azilsartan 40 80 q 24 h 100% q 24 h 100% q 24 h 50% q 24 h
Verapamil 180 480 q 24 h 100% q 24 h 100% q 24 h 100% q 24 h
Diltiazem 180 480 q 24 h 100% q 24 h 100% q 24 h 100% q 24 h
Nifedipine 10 30 q8h 100% q8h 100% q8h 100% q8h
Amlodipine 2.5 10 q 24 h 100% q 24 h 100% q 24 h 100% q 24 h
Felodipine 2.5 10 q 24 h 100% q 24 h 100% q 24 h 100% q 24 h
Nicardipine 20 40 tid 100% tid 100% tid 100% tid
Manidipine 5 20 q 24 h 100% q 24 h 100% q 24 h 100% q 24 h
Lercanidipine 10 20 q 24 h 100% q 24 h 100% q 24 h 100% q 24 h
Propranolol 80 160 bid 100% bid 100% bid 100% bid
Atenolol 50 100 q 24 h 50 100 mg q 24 h 25 50 mg q 24 h 25 mg q 24 h
Metoprolol 50 400 q 24 h 100% q 24 h 100% q 24 h 100% q 24 h
Carvedilol 6.25 25 q 12 24 h 100% q 12 24 h 100% q 12 24 h 100% q 12 24 h
Bisoprolol 5 20 q 24 h 100% q 24 h 75% q 24 h 50% q 24 h
Hydralazine 25 50 q8h 100% q8h 100% q8h 100% q 8 16 h
Minoxidil 5 30 bid 100% bid 100% bid 100% bid
Methyldopa 250-500 q8h 100% q8h 100% q 8 12 h 100% q 12 24 h
Prazosin 1 15 bid tid 100% bid tid 100% bid tid 100% bid tid
Doxazosin 1 16 q 24 h 100% q 24 h 100% q 24 h 100% q 24 h
: GFR Cockroft-Gault formula
[(140-age) x body weight] x (0.85 in female)
GFR =
(Scr x 72)

5.6
5.6.1
randomized-controlled clinical trials
40

42

CVD

ACEIs, ARBs DRI
teratogenic effects
5.6.2

American Congress of Obstetricians and
Gynecologists

(hypertensive crisis; SBP > 160 / DBP > 110 )

methyldopa, labetalol
nifedipine methyldopa
nifedipine CCB
labetalol
(fetal growth retardation)
RAAS
ACEIs ARBs DRI
(severe preeclampsia)


hydralazine labetalol nifedipine
sodium nitroprusside
nitroglycerin magnesium sulfate

43


1. ACOG Committee on Practice Bulletins--Obstetrics. ACOG practice bulletin. Diagnosis

and management of preeclampsia and eclampsia. Number 33, January 2002. Obstet
Gynecol 2002;99:159-67.
2. Alberti KG, Eckel RH, Grundy SM, et al. Harmonizing the metabolic syndrome: a joint
interim statement of the International Diabetes Federation Task Force on Epidemiology and
Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World
Heart Federation; International Atherosclerosis Society; and International Association for
the Study of Obesity. Circulation 2009;120:1640-5.
3. American College of Obstetricians and Gynecologists; Task Force on Hypertension in
Pregnancy. Hypertension in Pregnancy. Report of the American College of Obstetricians
and Gynecologists Task Force on Hypertension in Pregnancy. Obstet Gynecol
2013;122:1122-31.
4. American Diabetes Association. Standards of medical care in diabetes 2011. Diabetes Care
2011;34:S11-61.
5. Anderson CS, Heeley E, Huang Y, et al; INTERACT 2 investigators. Rapid blood-pressure
lowering in patients with acute intracerebral hemorrhage. N Engl J Med 2013;368:2355-65.
6. Australia National Health and Medical Research Council Dietary Salt Study Management
Committee. Fall in blood pressure with moderate reduction in dietary salt intake in mild
hypertension. Lancet 1989;1:399-402.
7. Beckett NS, Peters R, Fletcher AE, et al; HYVET Study Group. Treatment of hypertension
in patients 80 years of age or older. N Engl J Med 2008;358:1887-98.
8. Beyer FR, Dickinson HO, Nicolson DJ, Ford GA, and Mason J. Combined calcium,
magnesium and potassium supplementation for the management of primary hypertension in
adults. Cochrane Database Syst Rev 2006;(3):CD004805.
9. Bhupathiraju SN, Wedick NM, Pan A, et al. Quantity and variety in fruit and vegetable
intake and risk of coronary heart disease. Am J Clin Nutr 2013;98:1514-23.

44
10. Brenner BM, Cooper ME, de Zeeuw D, et al; RENAAL Study Investigators. Effects of
Iosartan on renal and cardiovascular outcomes in patients with type 2 diabetes and
nephropathy. N Engl J Med 2001;345:861-9.
11. Buse JB, Ginsberg HN, Bakris GL, et al. Primary prevention of cardiovascular diseases in
people with diabetes mellitus: a scientific statement from the American Heart Association
and the American Diabetes Association. Circulation 2007;115:114-26.
12. Canadian Hypertension Education Program (CHEP). Management of hypertension for
people with diabetes. Available from http: //www.hypertension.ca/education (Accessed on
14 October 2011).
13. Chobanian AV, Bakris GL, Black HR, et al; National Heart, Lung, and Blood Institute Joint
National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood
Pressure; National High Blood Pressure Education Program Coordinating Committee. The
Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and
Treatment of High Blood Pressure. JAMA 2003; 289:2560-72.
14. Cushman WC, Evans GW, Byington RP, et al; ACCORD Study Group. Effects of intensive
blood-pressure control in type 2 diabetes mellitus. N Engl J Med 2010;362:1575-85.
15. Dickinson HO, Nicolson DJ, Campbell F, Beyer FR, and Mason J. Potassium
supplementation for the management of primary hypertension in adults. Cochrane database
Syst Rev2006;(3):CD004641.
16. Dickinson HO, Nocolson DJ, Campbell F, et al. Magnesium supplementation for the
management of essential hypertension in adults. Cochrane Database Syst Rev
2006;(3):CD004640.
17. ESH/ESC Task Force for the Management of Arterial Hypertension. 2013 Practice
guidelines for the management of arterial hypertension of the European Society of
Hypertension (ESH) and the European Society of Cardiology (ESC): ESH/ESC Task Force
for the Management of Arterial Hypertension. J Hypertens 2013;31:1925-38.
18. Fagard RH. Exercise characteristics and blood pressure response to dynamic physical
training. Med Sci Sport Exerc 2001;33:S484-92.

45
19. Gonzalez-Campoy JM, St Jeor ST, Castorino K, et al. Clinical practice guidelines for
healthy eating for the prevention and treatment of metabolic and endocrine diseases in
adults: cosponsored by the American Association of Clinical Endocrinologists/the
American College of Endocrinology and the Obesity Society. Endocr Pract 2013;19:1-82.
20. Grossman E, Messerli FH, Grodzicki T, Kowey P. Should a moratorium be placed on
sublingual nifedipine capsules given for hypertensive emergencies and pseudoemergencies?
JAMA 1996;276:1328-31.
21. Gueyffier F, Bulpitt C, Boissel JP, et al. Antihypertensive drugs in very old people: a
subgroup meta-analysis of randomized controlled trials. INDANA Group. Lancet
1999;353:793-6.
22. Hackam DG, Quinn RR, Ravani P, et al; Canadian Hypertension Education Program. The
2013 Canadian Hypertension Education Program Recommendations for Blood Pressure
Measurement, Diagnosis, Assessment of Risk, Prevention and Treatment of Hypertension.
Canadian J of Cardiol 2013;29:528-42.
23. Hansson L, Zanchetti A, Carruthers SG, et al. Effects of intensive blood-pressure lowering
and low-dose aspirin in patients with hypertension: principle results of the Hypertension
Optimal Treatment (HOT) randomized trial. Lancet 1998;351:1755-62.
24. James PA, Oparil S, Carter BL, et al. 2014 Evidence-Based Guideline for the Management
of High Blood Pressure in Adults. Report From the Panel Members Appointed to the Eight
Joint National Committee (JNC 8). JAMA 2014;311:507-20.
25. JATOS Study Group. Principal result of the Japanese trial to assess optimal systolic blood
pressure in elderly hypertensive patients (JATOS). Hypertens Res 2008;31:2115-27.
26. 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;157:2413-46.
27. Kaufmann H. Consensus statement on the definition of postural hypotension, pure
autonomic failure and multiple system atrophy. Clin Auton Res 1996;6:125-6.

46
28. Klag MJ, Whelton PK, Randall BL, et al. Blood pressure and end-stage renal disease in
men. N Engl J Med 1996;334:13-8.
29. Klahr S, Levey AS, Beck GJ, et al for the Modification of Diet in Renal Disease Study
Group. The effects of dietary protein restriction and blood-pressure control on the
progression of chronic renal disease. N Engl J Med 1994;330:877-84.
30. Krause T, Lovibond K, Caulfield M, McCormack T, Williams B. Management of
hypertension: summery of NICE guidance. BMJ 2011;343:d4891.
31. Krause T, Lovibond K, Caulfield M, McCormack T, WilliamsB; Guideline Development
Group. Management of hypertension: summary of NICE Guidance. BMJ 2011;343:d4891.
32. Leenders M, Boshuizen HC, Ferrari P, et al. Fruit and vegetable intake and cause-specific
mortality in the EPIC study. Eur J Epidemiol 2014;29:639-52.
33. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Prospective Studies Collaboration.
Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of
individual data for one million adults in 61 prospective studies. Lancet 2002;360:1903-13.
34. Lewis EJ, Hunsicker LG, Bain RP, Rhode RD. The effect of angiotensin-converting-
enzyme inhibition on diabetic nephropathy. N Engl J Med 1993;329:1456-62.
35. Lewis EJ, Hunsicker LG, Clarke WR, et al; Collaborative Study Group. Renoprotective
effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to
type 2 diabetes. N Engl J Med 2001;345:851-60.
36. Litt J. Smoking and GPs: time to cough up: successful interventions in general practice.
Aust Fam Physician 2005;34:425-9.
37. Mancia G, De Backer G, Dominiczak A, et al. Management of Arterial Hypertension of the
European Society of Hypertension; European Society of Cardiology. 2007 Guidelines for
the Management of Arterial Hypertension: The Task Force for the Management of Arterial
Hypertension of the European Society of Hypertension (ESH) and of the European Society
of Cardiology (ESC). J Hypertens 2007;25:1105-87.

47
38. Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC Guidelines for the Management
of arterial hypertension. The Task Force for the management of arterial hypertension of the
European Society of Hypertension (ESH) and of the European Society of Cardiology
(ESC). Eur Heart J 2013;34:2159-219.
39. Mancia G, Laurent S, Agabiti-Rosei E, et al; European Society of Hypertension.
Reappraisal of European guidelines on hypertension management: a European Society of
Hypertension Task Force document. J Hypertens 2009;27:2121-58.
40. Martin JN Jr, Thigpen BD, Moore RC, et al. Stroke and Severe Preeclampsia and
Eclampsia: A paradigm shift focusing on systolic blood pressure. Obstet Gynecol
2005;105:246-54.
41. Masaki KH, Schatz IJ, Burchfiel CM, et al. Orthostatic hypotension predicts mortality in
elderly men: the Honolulu Heart Program. Circulation 1998;98:2290-5.
42. Mertens IL, Van Gaal LF. Overweight, obesity, and blood pressure: the effects of modest
weight reduction. Obes Res 2008;8:270-8.
43. Mora S, Cook N, Buring JE, Ridker PM, Lee IM. Physical activity and reduced risk of
cardiovascular events: potential mediating mechanisms. Circulation 2007;116:2110-8.
44. National Collaborating Centre for Women's and Children's Health. Hypertension in
pregnancy. The management of hypertensive disorders during pregnancy. London (UK):
National Institute for Health and Clinical Excellence (NICE); 2010 Aug d.6p (Clinical
guideline; no. 107) Available from http:1/www.NICE.org.uk.cg 107 (Accessed on 14
October 2011)
45. National Health and Medical Research Council. Clinical practice guidelines for the
management of overweight and obesity in adults. Canberra: Commonwealth of Australia,
2003.
46. National Heart Foundation of Australia (National Blood Pressure and Vascular Disease
Advisory Committee). Guide to management of hypertension 2008. Update December
2010. Available at :
http://www.heartfoundation.org.au/SiteCollectionDocuments/HypertensionGuidelines2008t
o2010Update.pdf

48
47. Ogihara T, Saruta T, Rakugi H, et al; Valsartan in Elderly Isolated Systolic Hypertension
Study Group. Target blood pressure for treatment of isolated systolic hypertension in the
elderly: Valsartan in Elderly Isolated Systolic Hypertension study. Hypertension
2010;56:196-202.
48. Podymow T, August P. Antihypertensive drugs in pregnancy. Semin Nephrol 2011;31:70-
85.
49. Primatesta P, Brookes M, Poulter NR. Improved hypertension management and control:
results from the health survey for England 1998. Hypertension 2001;38:827-32.
50. Puavilai W, Laorugpongse D, Prompongsa A, et al. J Med Assoc Thai 2011;94:1069-76.
51. Rabi OM, Daskalopoulou SS, Padwal RS, et al; Canadian Hypertension Education
Program. The 2011 Canadian Hypertension Education Program. The 2011 Canadian
Hypertension Education Program recommendations for the management of hypertension:
blood pressure measurement, diagnosis, assessment of risk, and therapy. Can J Cardiol
2011;27:415-33.
52. Ruggenenti P, Perna A, Gherardi G, et al. Renal function and requirement for dialysis in
chronic nephropathy patients on long-term ramipril: REIN follow-up trial. on behalf of
Gruppo Italiano di Studi Epidemiologici in Nefrologia (GISEN). Ramipril Efficacy in
Nephropathy. Lancet 1998;352:1252-6.
53. Ruggenenti P, Perna A, Gherardi G, et al. Renoprotective properties of ACE-inhibition in
non-diabetic nephropathies with non-nephrotic proteinuria. Lancet 1999;354:359-64.
54. Sarnak MJ, Greene T, Wang X, et al. The effect of a lower target blood pressure on the
progression of kidney disease: long-term follow-up of the modification of diet in renal
disease study. Ann Intern Med 2005;142:342-51.
55. Schroeder BM; American College of Obstetricians and Gynecologists. ACOG practice
bulletin on diagnosing and managing preeclampsia and eclampsia. American College of
Obstericians and Gynecologists. Am Fam Physician 2002;66:330-1.
56. Scottish Intercollegiate Guidelines Network. Management of obesity, a National Clinical
Guideline. NHS Quality Improvement Scotland, 2010.

49
57. Sibai BM, Mercer BM, Schiff E, Friedman SA. Aggressive versus expectant management
for patients with severe preeclampsia between 28-34 weeks gestation: a randomized
controlled trial. Am J Obstet Gynecol 1994;171:818-22.
58. Somes GW, Pahor M, Shorr Rl, Cushman WC, Applegate WB. The role of diastolic blood
pressure when treating isolated systolic hypertension. Arch Intern Med 1999;159:2004-9.
59. SPS3 Study Group, Benavente OR, Coffey CS, Conwit R, et al. Blood-pressure targets in
patients with recent lacunar stroke: the SPS3 randomised trial. Lancet 2013;382:507-15.
60. Stewart KJ. Exercise training and the cardiovascular consequences of type 2 diabetes and
hypertension: plausible mechanisms for improving cardiovascular health. JAMA
2002;288:1622-31.
61. Tejada T, Fornoni A, Lenz O, Materson BJ. Nonpharmacologic therapy for hypertension:
does it really work? Curr Cardiol Rep 2006;8:418-24.
62. The GISEN Group (Gruppo Italiano di Studi Epidemiologici in Nefrologia). Randomised
placebo-controlled trial of effect of ramipril on decline in glomerular filtration rate and risk
of terminal renal failure in proteinuric, nondiabetic nephropathy. Lancet 1997;349:1857-63.
63. The National High Blood Pressure Education Program. Working Group on High Blood
Pressure in Pregnancy. Report of the National High Blood Pressure Education Program
Working group report on high blood pressure in pregnancy. Am J Obstet Gynecol
2000;183:S1-S22.
64. Wang X, Ouyang Y, Liu J, et al. Fruit and vegetable consumption and mortality from all
causes, cardiovascular disease, and cancer: systematic review and dose-response meta-
analysis of prospective cohort studies. BMJ 2014;349:g4490.
65. Wataganara T, Titapant V. Management guidelines for preeclampsia. Siriraj Hosp Gaz
2004;56:604-16.
66. Weber MA, Schiffrin EL, White WB, et al. Clinical practice guidelines for the management
of hypertension in the community: a statement by the American Society of Hypertension
and the International Society of Hypertension. J Clin Hypertens 2014;16:14-26.

50
67. Weber MA, Schiffrin EL, White WB, et al. Clinical practice guidelines for the management
of hypertension in the community a statement by the American Society of Hypertension
and the International Society of Hypertension. J Hypertens 2014;32:3-15.
68. Whelton PK, Appel LJ, Espeland MA, et al. Sodium reduction and weight loss in the
treatment of hypertension in older persons. A randomised controlled trial of
nonpharmacological interventions in the elderly (TONE). TONE Collaborative Research
Group. JAMA 1998;279:839-46.
69. Whelton SP, Chin A, Xin X, and He J. Effect of aerobic exercise on blood pressure: a meta-
analysis of randomized controlled trials. Ann Int Med 2002;136:493-503.
70. World Health Organization (WHO). Obesity: preventing and managing the global
epidemic: report of a joint WHO/FAO expert consultation. WHO technical report series;
894. Geneva:WHO, 2000.
71. World Health Organization, International Society of Hypertension Writing Group. 2003
World Health Organization (WHO)/International Society of Hypertension (ISH) statement
on management of hypertension. J Hypertens 2003;21:1983-92.
72. Yusuf S, Teo KK, Pogue J, et al; ONTARGET Investigators. Telmisartan, ramipril, or both
in patients at high risk for vascular events. N Engl J Med 2008;358:1547-59.
73.
.
2553.
74. 2555.

1.
;2555. Available at: http://www.diabassocthai.org/news and
knowledge/62
75. .
. 1. : ;2555.

51
76. ,
,
. .. 2557 29-36.
77. .
. 2543;62-63.

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Thai Guidelines on The Treatment of Hypertension

2558