The revision committee of the 2019 Thai Guidelines on the Treatment of Hypertension has reviewed new developments in the body of knowledge, together with the expertise in real-life clinical practice and evidence collected from clinical studies worldwide. The guidelines consist of newly highlighted key topics to ensure the guidelines remain up to date, user friendly, and suitable for the country’s context. The guidelines still maintain the current office blood pressure (BP) cut-off point of 140/90 mmHg for the diagnosis of hypertension. The use of out-of-office BP measurements, including home BP monitoring (HBPM) or ambulatory BP monitoring (ABPM), is also advocated to confirm the diagnosis of hypertension. Target BP levels depend on the age of the patients, such as 120 to 130/70 to 79 mmHg for patients aged 18 to 65 years old, or 130 to 139/70 to 79 mmHg for patients over 65 years of age. There are five main groups of antihypertensive medication, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, calcium-channel blockers, and thiazides or thiazide-like diuretics. Two types of medications should be started for most patients, except for frail elderly patients, patients with a relatively low initial BP of 140 to 149/90 to 99 mmHg, and low-risk patients, in which only one type of starting medication should be selected. Medication that involves a combination of two types in one pill should ideally be selected. Keywords: Hypertension; Guidelines; Thailand
Hypertension remains a significant risk factor for major cardiovascular events worldwide. Poor adherence to treatment is extremely common in clinical practice, leading to uncontrolled hypertension. However, some patients with resistant hypertension still have uncontrolled blood pressure despite good medical compliance. A specific group of patients also develop adverse reactions to many blood pressure-lowering medications. These scenarios indicate that innovative strategies to lower blood pressure in challenging cases of hypertension are needed. The blood pressure-lowering efficacy of catheter-based renal denervation therapy to decrease sympathetic tone has been confirmed in many publications in recent years. Apart from both the invasiveness and the expensiveness of this technology, appropriate case selection to undergo this procedure is still developing. The utilization of renal denervation therapy for hypertension treatment in Thailand has lasted for 10 years with a good response in most cases. Currently, only certain interventionists at a few medical schools in Thailand can perform this procedure. However, more physicians are now interested in applying this technology to their patients. The Thai Hypertension Society Committee has reviewed updated information to provide principles for the appropriate utilization of renal denervation therapy. The blood pressure-lowering mechanism, efficacy, suitable patient selection, pre- and postprocedural assessment and procedural safety of renal denervation are included in this statement.
Hypertension is a powerful modifiable risk factor for cardiovascular disease. The prevalence of hypertension in Thailand is increasing progressively. Patients with hypertension are usually asymptomatic, and thus proper blood pressure measurement is required to diagnose and assess the blood pressure control. Home blood pressure monitoring (HBPM) is recognized as a useful tool in hypertension management and is recommended by many organizations, including the Thai Hypertension Society. The proven benefits of HBPM beyond the usual clinic measurement is that it allowed detection of white-coat hypertension and masked hypertension, better prediction of cardiovascular events, better assessment of the status of blood pressure control, and improved treatment compliance. Despite these benefits, the use of HBPM has remained low in many countries. The Asia HBPM Survey is a collaborative study of participants from 11 countries in Asia. The present study aimed to investigate physicians’ rationale, challenge, and attitudes toward the use of HBPM for hypertensive patients. Herein, the authors report Thai physicians’ responses in the Asia HBPM Survey.
High sodium intake is a worldwide problem and contributes to high blood pressure and target organ damage. Measurement of 24-hour urine sodium excretion is gold standard for sodium intake evaluation but it is difficult to practice. In this study, the correlation between spot urine sodium:creatinine ratio from second void (AM), before dinner (PM), before bedtime (HS) and 24-hr samples with 24-hour urine sodium were evaluated. Methods:The participants were recruited from single hospital. Participants with age > 20 years, eGFR > 60 ml/min/1.73 m2 and no history of diuretics use were included. Urine sodium, urine creatinine and urine volume of each sample were measured. Urine sodium (mmol/L):urine creatinine (mg/dL) ratio of AM, PM, HS and 24-hour samples were calculated. Correlations of each ratio with 24 hour urine sodium (mmol/day) were studied by Pearson correlation coefficients.Results: 43 participants were included in this study. Mean age was 46.9 ± 13.6 years. Hypertension was diagnosed in 31 participants (72%). Mean blood pressure was 134 ± 15/81 ± 9 mmHg. Estimated eGFR was 100 ± 16 ml/min/1.73 m2.Mean 24 hour urine sodium was 178 + 92 mmol/day (equivalent to sodium intake 4,094 + 2,116 mg/day). Urine sodium:creatinine ratio of AM, PM, HS and 24-hr samples (correlation coefficient, r, with 24-hour urine sodium excretion) were 1.6 ± 0.8 (r = 0.11,P = 0.49), 1.9 ± 1.1 (r = 0.71, P < 0.001), 1.7 ± 1.1 (r = 0.59, P < 0.001) and 1.8 ± 0.7 (r = 0.77, < 0.001) respectively. Spot urine sodium:creatinine ratio from PM sample cut-off point of 1.2 had sensitivity of 81% and specificity of 73 % to determine 24-hr urine sodium of 100 mmol/day.
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