Thai hypertension guideline 2012

Click here to load reader

  • date post

    18-Mar-2016
  • Category

    Documents

  • view

    215
  • download

    0

Embed Size (px)

description

source: สมาคมความดันโลหิตสูงประเทศไทย

Transcript of Thai hypertension guideline 2012

  • 1

    (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 (SBP < 140 . DBP < 90 .) (SBP 135 . / DBP 85 .)

    1.2 1.2.1

  • 2 30 5 2

    1.2.2 (mercury sphygmomanometer)

    (automatic blood pressure monitoring device) arm cuff (bladder) 80 arm cuff 12 . x 22.

    1.2.3 - (non-dominant arm)

    arm cuff 2-3 . brachial

    - SBP (rubber bulb) brachial 2-3 ./ SBP

    - bell diaphragm stetho-scope brachial SBP 20-30 . (Korotkoff sound phase I) SBP (Korotkoff sound phase V) DBP

    - 3 1-2 2 ( +/ II)

    - ( +/ II) 20/10 .

    - 10 SBP > 10 .

  • 3- 3 (+/ II)

    SBP SBP 20 . orthostatic hypotension orthostatic hypotension SBP SBP

    1.3 ( 1)

    1.4 (Home or self blood pressure measurement)

    1.4.1. ( 1.2.1 1.2.2)1.4.2.

    1 () 18

    : SBP - systolic blood pressure, DBP - diastolic blood pressure, SBP DBP ISH SBP

  • 41.4.3 2 / 4-7 (+/ II)

    1.4.4. mercury sphygmoma-nometer 5 . SBP 135 ./ DBP 85 .

    1.4.5. isolated office hypertension

    1.5 1.5.1 140/90 . 2

    (home BP monitoring, HBPM) ( +/ II)

    1.5.2 (target organ damage, TOD) ( ++/ II)

    1.5.3 (left ventricular hypertrophy, LVH), (chronickidney disease, CKD) (hyperten-sive retinopathy) (cardiovas-cular disease, CVD) ( +/ II)

    1.5.4 TOD LVH, albu-minuria proteinuria TOD ( +/ II)

    1.5.5 140/90 . ( +/ II)

    1.5.6 HBPM

    - 2 1 ( +/ II)

    - 2 / ( +/

  • 5 II)- 4-7

    ( +/ II)

    1.5.7 () - accelerated malignant hypertension

    180/110 . (retinalhemorrhage) (papilledema) ( +/II)

    - pheochromocytoma labile postural hypotension ( +/ II)

    1.5.8 () (secondary hypertension) ( +/ II)

  • 6 2

    4 1.

    sphygmomanometer 140/90 . 135/85 .

    2. TOD LVH, hypertensive retinopathy, (microalbuminuria, MAU) (macro-albuminuria)

    3. CVD CVD 10

    4. CVD

    . CVD

    (dyslipidemia) . TOD. CVD

    CVD CKD

    CVD statin (antiplatelets)

    2.1 2.1.1

  • 7 -blocker (diuretics)

    2.1.2 (primary hypertension) polycystic kidney disease pheochromocytoma

    2.1.3 CVD () CVD (55 65 ) (obstructive sleep apnea, OSA) (personality type A)

    2.1.4 TOD (intermittent claudication)

    2.1.5 pheochromocytoma primary aldosteronism 2 (renal stone) (pyelonephritis) ,cocaine, amphetamine, steroids, NSAIDs, pseudoephredine

    2.1.6 CVD -blocker, diuretics

  • 82.2 2.2.1

    ( 1) 3 1-2 2 TOD

    2.2.2. TOD ( 2)

    2

  • 92.2.4. (bodymass index, BMI) BMI 23 ./2 BMI 25 ./2 90 . 80 .

    :

    3

    2.2.3 ( 3)

  • 10

    2.3 2.3.1

    ( +/ II)1. Fasting plasma glucose (FPG)2. Serum total cholesterol, HDL-C, LDL-C, fasting serum triglyceride

    12 3. Serum electrolytes, creatinine estimated creatinine clearance

    (Cockroft-Gault formula) glomerular filtration rate (MDRD formula)4. Hemoglobin hematocrit5. Urinalysis (dipstick test urine sediment)6. Electrocardiography (EKG)

    2.3.2 ( +/ IV) CVD

    1. Echocardiography 2. Carotid ultrasonography carotid bruit3. Ankle brachial BP index (ABI) pulse wave velocity (PWV)

    4. Glucose tolerance test fasting plasma glucose 100 ./.5. Microalbuminuria (MAU)6. proteinuria urine protein/creatinine ratio

    dipstick

  • 11

    7. 24 (24 hrambulatory BP monitoring)

    8. (fundoscopy)

    2.3.3 ()1.

    (computerized cerebral angiography), (coro-nary angiography) (peripheral arterial an-giography)

    2. renin, aldosterone,corticosteroid, catecholamines arteriography ultrasonography CT MRI

    2.4 2.4.1 SBP DBP ( 1-3)2.4.2 pulse pressure > 90 . ( 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 Glucose tolerance test 2.4.8 CVD (

    55 65 )2.4.9 90 . 80 .

    2.5 (subclinical target organ damage)

    CVD

  • 12

    ( +/ II)2.5.1 Electrocardiography LVH (Sokolow-Lyon > 38 mm,

    Cornell > 2440 mm.ms)2.5.2 Echocardiography LVH (LVMI 125 /2

    110 /2 )2.5.3 Carotid wall thickness (IMT > 0.9 .) plaque2.5.4 Carotid-femoral pulse wave velocity > 12 ./2.5.5 Ankle/brachial BP index < 0.92.5.6 serum creatinine (1.3-1.5 ./. 1.2-1.4 ./

    .)2.5.7 GFR < 60 .//1.73 2 (MDRD formula) creatinine

    clearance < 60 ./ (Cockroft-Gault formula)2.5.8 MAU (30-300 /) albumin-creatinine

    ratio 20-200 ./ 30-300 ./

    2.6 2.6.1 FPG 126 ./. 2.6.2 Postload plasma glucose 200 ./.

    2.7 (Established cardiovascular andrenal disease)

    2.7.1 - Ischemic stroke- Cerebral hemorrhage- Transient ischemic attack

    2.7.2 - Myocardial infarction- Angina- Coronary revascularization- Heart failure

    2.7.3 - Diabetic nephropathy

  • 13

    - : serum creatinine > 1.5 ./. > 1.4 ./.

    - Albuminuria > 300 ./ proteinuria > 500 ./2.7.4 2.7.5

    - Hemorrhage- Exudates- Papilledema

    2.8 10 CVD

    CVD 10 ( ++/ I) ( 4)

    4 10

    : MS - metabolic syndrome, TOD - target organ damage, 10 < 15% , 15 < 20% , 20-30% , > 30%

  • 14

    2.9 CVD 2.9.1 2.9.2 SBP > 160 . DBP < 70 . (pulse

    pressure > 90 . )2.9.3 2.9.4 2.9.5 CVD 3 2.9.6 TOD 2.9.7 CVD

    2.10 2.10.1 2007 European Society of Hypertension (ESH)/

    European Society of Cardiology (ESC) guideline ( 4) CVD Framingham Heart Score SCORE (Systematic Coro-nary Risk Estimation) CVD low risk chart

    2.10.2 CVD CVD

  • 15

    3

    3.1 ( 5)

    5

  • 16

    3.2

    CVD 10 ( 4) ( 6) ( ++/ I) CVD ( ++/ I) ( 1)

    6

  • 17

    1

    3.3 3.3.1 BP < 140/90 . ( ++/ I)3.3.2 BP < 130/80 . ( +/

    II)3.3.3 BP 130-139/80-85 . ( +/

    II)3.3.4 BP < 130/80 . proteinuria < 1 /

    ( ++/ I) < 125/75 . proteinuria > 1/ ( / II)

  • 18

    3.3.5 BP < 130/80 . CVD CVD ( +/ II)

    3.4 3.4.1

    4

    - Thiazide-type diuretics- Calcium channel blockers (CCBs)- Angiotensin converting enzyme inhibitors (ACEIs)- Angiotensin II receptor blockers (ARBs) -blocker

    -blocker ( -/ II) -blocker myocardial infarction tachyarrhythmia ( -/ II) renin-angiotensin-aldosterone (RAASblockers) direct renin inhibitor (DRI) RAAS blockers ACEIs ARBs DRI

    methyldopa, clonidine, reserpine ( / II)

    3.4.2 ( 7) ( +/ I)

  • 19

    7

    : LVH - left ventricular hypertrophy, ISH - isolated systolic hypertension, ESRD- end-stage renal disease, ACEIs - angiotensin converting enzyme inhibitors,ARBs - angiotensin II receptor blockers, CCBs -calcium channel blockers,BBs - -blockers, DHP-CCBs: dihydropyridine calcium channel blockers;non-DHP CCBs: non-dihydropyridine calcium channel blockers

  • 20

    3.4.3 ( 8)

    8

    : A:ACEIs ARBs ( ACEIs ARBs)( +/ I)

    C: Calcium channel blockers ( diuretics) ( +/ II)

    D:Diuretic ( )

    3.4.4 > 20/10 . 2 ( +/II)

    3.4.5 2 (+/ II) ( 1)

    1

  • 21

    3.4.6 ( 9)

    9

    3.5 isolated systolic hypertension (ISH)3.5.1 diuretics DHP-CCBs ( +/

    II) diuretics (hypokalemia)

    3.5.2 di-uretics DHP-CCBs ( +/ II)

    3.5.3 2 -blockers, ACEIs,ARBs, central acting drugs non-DHP CCBs ( +/ II)

  • 22

    3.6

    CVD

    ( ++/ I) ( +/II)

    3.7 3.7.1. ( +/

    II)3.7.2 ( +/

    II)3.7.3 ISH SBP DBP

    ( +/ II)3.7.4 80 55-

    80 ( +/ II)3.7.5 ACEIs ARBs ( -/ II)3.7.6 -blocker

    - (coronary artery disease) ( ++/ I)

    - tachyarrhythmia ( +/ II)- ACEIs ARBs ( +/

    II)- ( +/ II)- sympathetic ( +/

    II)3.7.7 -blocker 2

    DHP-CCBs diuretics (

  • 23

    +/ II)3.7.8 DHP-CCBs 2

    diuretics ( +/ II)

    3.7.9 3 2

    3.7.10 diuretics 2 hydrochlorothiazide (HCTZ) spironolactone (step 4) 1 ( +/ II)

    3.7.11 step 4 (drugcompliance) WCH (+/ II)

    3.7.12 spironolactone (hyperkale-mia) ACEIs ARBs eGFR < 60 / < 4.5 / (+/ II) eGFR 2 ( +/ II) 3-4 spironolactone

    3.7.13 4 (hypertension specialists)

    3.7.14 white coat effect 20/10 . ( +/ II)

  • 24

    4

    4.1 (

    10)

    4.2

    1

    4.3 4.3.1

    4.3.2

    4.3.3 , e-mail

    10 ()

  • 25

    4.3.4 4.3.5 4.3.6 4.3.7

    4.3.8 4.3.9

    4.3.10

    4.3.11

    4.3.12

  • 26

    5

    5.1 ( 60 )

    (aging society) .. 2547 72-80 ( 14-27) ( 43-48)

    5.1.1 5.1.1.1 ( 1.2.3) . atrial fibrillation

    ( ++/ I). (variability)

    50 WCH white-coat effect

    - TOD ( ++/II)

    - (postprandial hypotension) ( +/ II)

    5.1.1.2

  • 27

    140/90 .5.1.2 5.1.2.1

    (atherosclerotic renovascular hypertension), primaryaldosteronism ( ++/ I)

    - 30

    - TOD

    - -

    - ACEIs ARBs5.1.2.2

    TOD CVD ( ++/ I)

    5.1.3 5.1.3.1

    (non-pharmacological treatment) ( ++/ I) ( 3.1)

    5.1.3.2

    . orthostatic hypotension ( 1.2.3) orthostatic hypotension 64

  • 28

    whitecoat effect ( ++/ II)

    . TOD ( ++/ I)

    . (pharma-codynamics) (pharmacokinetics) 80 JNC-7 84 INDANA > 60 80 874 796 34 22 39 CVD 14 > 80 The Hypertension inthe Very Elderly Trial (HYVET) .. 2008 SBP 160 . indapamide / perindopril < 150/80 . (fatal stroke) (nonfatalstroke) 30 64 INDANA 21 80 < 150/80 . ( +/ II)

  • 29

    . 1.

    diuretics thiazide TOD HCTZ 12.5-25 diuretics potassium-sparing ( ++/ I)

    2. (polyphar-macy) 11 ( ++/ II) -blockers

    3. - methyldopa reserpine (

    --/ II)- labetalol methyldopa (

    --/ II)- methyldopa

    (delirium) (--)

    - nifedipine first pass metabolism (--/ II)

    .

  • 30

    11

  • 31

    Hypertension Optimal Treatment Study (HOT) CVD DBP 82.6 . DBP 86.5 . CVD DBP 82 . orthostatic hypotension

    Systolic Hypertension in the Elderly Program (SHEP) DBP 5 . 77 . CVD 11-14 J-curve phenomenon DBP SBP SBP 140-145 . DBP 80-85. ( ++/ I)

    5.2 (coronaryartery disease, CAD)

    (primary prevention) (secondary prevention)

    5.2.1 Primary prevention ( 3.3)

    < 130/80 . carotid (abdominal aortic aneurysm) ( ++/ I)

    Secondary prevention < 130/80 stable an-gina, acute coronary syndrome ( +)

    DBP (coronary bloodflow) DBP (< 60 .) ( -)

  • 32

    5.2.2 (12)

    -blocker primary prevention angina pectoris -blockers ( +/ II) CCBs pri-mary prevention stable angina ( +) non- DHP CCBs ( -) CCBs nifedipine (--)

    12

    : ACEIs - angiotensin converting enzyme inhibitors, ARBs - angiotensin IIreceptor blocker, CCBs - calcium channel blockers, CAD - coronary arterydisease, ACS - acute coronary syndrome, NSTEMI - non-ST-segmentelevation myocardial infarction, STEMI - ST-segment elevation myocardialinfarction

  • 33

    5.3 60 (acute stroke)

    (amplitude) (full bladder) (aorticdissection) (hypertensiveencephalopathy) (acute renal failure) (acute pulmonary edema) (acute myocardialinfarction) 5-10 2-3

    5.3.1 2

    5.3.1.1 ( 72 ) 2

    . (tis-sue plasminogen activator, t-PA)

    - t-PA SBP < 185 . DBP < 110 . nicardipine 2 . 1-2 5 ./. 2.5 ./. 10-15 labetalol 10 . 1- 2 2-8 ./

    - t-PA 15 2 1 24

  • 34

    < 180/105 . 24

    (sodium nitroprusside) nifedipine

    . t-PA SBP < 220 . DBP < 120 . 2-3 10-15 DBP < 110 . 30-60 160/100 . 2

    120/80 . 200/120 . SBP < 100 . DBP < 70 .

    5.3.1.2

    (transient ischemic attack, TIA) < 130/80 . ACEIsdiuretics ACEIs ARBs

    5.3.2

  • 35

    5.3.2.1 24 ( ++/ I)

    5.3.2.2 ( +/ II) 10/5 . diuretics / ACEIs

    5.3.2.3 < 130/80 . ( +/ II) ( +/ II)

    5.4

    CVD CVD 10 20

    5.4.1 CVD

    115/75 . CVD 130/80 . 130/80 .

    The Action to Control Cardiovascular Risk in Diabetes(ACCORD) (SBP

  • 36

    4.7 CVD 130-139/80-85 .( ++/ I)

    5.4.2 5 diuretics, CCBs, ACEIs, ARBs -

    blockers CVD ACEIs ARBs ( ++/ I)

    ACEIs ARBs ( ++/ I)

    diuretics -blockers

    ACEIs ARBs 2 RAAS ACEIs ARBs mineralocorticoid receptor antagonists RAAS blockers ( ++/I)

    5.5 5.5.1 CKD

    < 130/80 . ( ++ / I)5.5.2 CKD ACEIs ARBs

    ( ++/ I)5.5.3 CKD ACEIs ARBs

  • 37

    ( ++ / I)5.5.4 CKD ACEIs ARBs

    ( 13) 30 < 5.5 /( ++ / III)

    5.5.5 CKD 2 ( ++/ II) 13 ACEIs ARBs CKD

    5.5.6 CKD (proteinuria) ACEIs ARBs ( +/ II)

    - (proteinuria) CKD (urine protein/creatinine ratio - UPCR) < 0.5-1.0 / ( + / II)

    - CKD (+/ II)

    5.5.7 CKD ACEIs ARBs ( + / II) ( +/ IV)

  • 38

    5.5.8 CKD ( 14) ( ++/ I)

    14

  • 39

    5.6 5.6.1 5.6.1.1 Chronic hypertension

    20 6

    5.6.1.2 Gestational hypertension 20 < 300 ./ < 300 ./

    5.6.1.3 Pre-eclampsia 20 > 300 ./ > 300 ./ 60 5-7

    5.6.1.4 Eclampsia pre-eclampsia5.6.1.5 HELLP syndrome

    5.6.2

    ( 15)

    5.6.3

    5.6.3.1 pre-eclampsia- - - 2

    15

  • 40

    - -

    5.6.3.2 (aspirin) 75 ./ 12 34

    ( ++/ I) .

    pre-eclampsia- - - autoimmune disease systemic lupus erythematosus (SLE)

    antiphospholipid syndrome- 1 2-

    . pre-eclampsia

    - - 40 - > 10 - BMI 30 ./2 - - (multiple pregnancy)

    5.6.3.3

    ( --/ II)- nitric oxide- progesterone- diuretics- low molecular weight heparin

    5.6.3.4

    ( -/ II)- magnesium

  • 41

    - folic acid- antioxidant vitamin C vitamin E- fish oil-

    5.6.3.5 gestational hyper-

    tension pre-eclampsia ( -/ II)5.6.3.6

    5.6.4 5.6.4.1 - - ACEIs, ARBs,

    diuretics (congenital abnormality) ( --/ II)

    5.6.4.2 ( +/ II)

    5.6.4.3 - TOD < 150/100 . DBP

    < 80 .- TOD < 140/90 .5.6.4.4 - 37

    < 160/110 . ( +/ II)-

    corticosteroid ( +/ II)5.6.4.5 . 4 . 2

    3-5 ( +/ II).

  • 42

    - 2 < 140/90.

    - methyldopa 2 ( +/ II)

    - 6-8 5.6.5 gestational hypertension gestational hypertension

    ( 16)

    - - 40 - > 10

    16 gestational hypertension

  • 43

    - pre-eclampsia - - BMI 30 ./2- 36 - pre-eclampsia gestational hypertension - CVD - 5.6.5.1 ( 5.6.4.4)5.6.5.2 ( 5.6.4.5)5.6.6 pre-eclampsia

    ( 17)

    17 pre-eclampsia

  • 44

    5.6.6.1 . pre-eclampsia

    - 34 corticosteroid

    - 34

    . pre-eclampsia 34-36

    24-48 . 37

    5.6.6.2

    . pre-eclampsia

    1. - 4 / - 3-5 -

    3-5 2.

    > 150/100 .. pre-eclampsia

    1.

    4 / 1-2 2

    2. - - BP < 140/90 .- BP < 130/80 .- methyldopa 2

  • 45

    - pre-eclampsia < 150/100. ( SGPT ) 6-8 1+ 3

    5.6.7 pre-eclampsia

    5.6.7.1 MgSO4

    4 5 1 /. 24 . MgSO4 2-4 5 diazepam, phenytoin MgSO4

    5.6.7.2

    SBP < 150 . DBP 80-100.

    - labetalol - hydralazine - nifedipine 5.6.7.3 corticosteroid (lung matu-

    ration) 24-34 7

    dexamethasone 5 . 4 12 . ( ++/ I) 35-36 dexamethasone HELLP syndrome ( -/ II)

    5.6.7.4 (volume expansion) hydralazine

    pre-eclampsia 80 ./. ( +/ II)

    5.6.7.5 (caesarean section) (induction of labour)

  • 46

    18 pre-eclampsia

    5.6.7.6

    ( 18)

    5.6.8 diuretics

    5.6.8.1 ( +/

    II)

  • 47

    - ACEIs: captopril, enalapril, quinapril- CCBs: diltiazem, nifedipine, verapamil- -blockers: labetalol, propranolol- Diuretics: furosemide, hydrochlorothiazide, spironolactone- Others: hydralazine, methyldopa, minoxidil

    5.6.8.2 ( / II)

    - ARBs- amlodipine- ACEIs

  • 48

    1. Australia National Health and Medical Research Council Dietary Salt Study Manage-

    ment Committee. Fall in blood pressure with moderate reduction in dietary salt intakein mild hypertension. Lancet 1989; 1(8635): 399-402.

    2. Beckett NS, Peters R, Fletcher AE, Staessen JA, Liu L, Dumitrascu D, et al., HYVETStudy Group. Treatment of hypertension in patients 80 years of age or older. N Engl JMed 2008; 358(18): 1887-98.

    3. Canadian Hypertension Education Program (CHEP). Management of hypertension forpeople with diabetes. Available from http://www.hypertension.ca/education (Accessedon 14 October 2011).

    4. Cushman WC, Evans GW, Byington RP, Goff DC Jr, Grimm RH Jr, Cutler JA, et al.Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med2010; 362: 1575-85.

    5. Gueyffier F, Bulpitt C, Boissel JP, Schron E, Ekbom T, Fagard R, et al. Antihyperten-sive drugs in very old people: a subgroup metaanalysis of randomized controlled trials.INDANA Group. Lancet 1999; 353(9155): 793-6.

    6. Hansson L, Zanchetti A, Carruthers SG, Dahlof B, Elmfeldt D, Julius S, et al. Effectsof intensive blood-pressure lowering and low-dose aspirin in patients with hyperten-sion: principal results of the Hypertension Optimal Treatment (HOT) randomised trial.Lancet 1998; 351(9118): 1755-62.

    7. Joint National Committee on Prevention, Detection, Evaluation and Treatment of HighBlood 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.

    8. Kaufmann H. Consensus statement on the definition of postural hypotension, pureautonomic failure and multiple system atrophy. Clin Auton Res 1996; 6(2): 125-6.

    9. Krause T, Lovibond K, Caulfield M, McCormack T, Williams B. On behalf of theGuideline Development Group. Management of hypertension: summary of NICEGuidance. BMJ 2011; 343: doi:10.1136/bmj.d4891.

    10. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Age-specific relevance ofusual blood pressure to vascular mortality: a meta-analysis of individual data for onemillion adults in 61 prospective studies. Lancet 2002; 360: 1903-13.

    11. Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, et al. 2007Guidelines for the Management of Arterial Hypertension: The Task Force for theManagement of Arterial Hypertension of the European Society of Hypertension (ESH)and of the European Society of Cardiology (ESC). J Hypertens 2007; 25: 1105-87.

    12. Mancia G, Laurent S, Agabiti-Rosei E, Ambrosioni E, Burnier M, Caulfield MJ, et al.

  • 49

    Reappraisal of European guidelines on hypertension management: a European Societyof Hypertension Task Force document. J Hypertens 2009; 27: 2121-58.

    13. Masaki KH, Schatz IJ, Burchfiel CM, Sharp DS, Chiu D, Foley D, et al. Posturalhypotension predicts mortality in elderly men: the Honolulu Heart Program. Circula-tion 1998; 98(21): 2290-5.

    14. National Collaborating Centre for Womens and Childrens Health. Hypertension inpregnancy. The management of hypertensive disorders during pregnancy. London (UK):National Institute for Health and Clinical Excellence (NICE); 2010 Aug 46p (Clinicalguideline; no. 107) Available from http://www.NICE.org.uk.cg 107 (Accessed on 14October 2011)

    15. Podymow T, August P. Antihypertensive drugs in pregnancy. Semin Nephrol 2011; 31:70-85.

    16. Rabi DM, Daskalopoulou SS, Padwal RS, Khan NA, Grover SA, Hackam DG, et al.Canadian Hypertension Education Program. The 2011 Canadian Hypertension Educa-tion Program recommendations for the management of hypertension: blood pressuremeasurement, diagnosis, assessment of risk, and therapy. Can J Cardiol 2011; 27(4):415-433. e1-2.

    17. Somes GW, Pahor M, Shorr RI, Cushman WC, Applegate WB. The role of diastolicblood pressure when treating isolated systolic hypertension. Arch Intern Med 1999;159(17): 2004-9.

    18. Standards of medical care in diabetes 2011. Diabetes Care 2011; 34 (Suppl 1): S11-61.19. 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: 2560-72.

    20. The Task Force for the Management of Arterial Hypertension of the European Societyof Hypertension (ESH) and of the European Society of Cardiology (ESC). 2007 Guide-lines for the Management of Arterial Hypertension. J Hypertens 2007; 25: 1105-87.

    21. Whelton PK, Appel LJ, Espeland MA, Applegate WB, Ettinger WH Jr, Kostis JB, et al.Sodium reduction and weight loss in the treatment of hypertension in older persons. Arandomised controlled trial of nonpharmacological interventions in the elderly (TONE).TONE Collaborative Research Group. JAMA 1998; 279(11): 839-46.

    22. World Health Organization, International Society of Hypertension Writing Group. 2003World Health Organization (WHO)/International Society of Hypertension (ISH) state-ment on management of hypertension. J Hypertens 2003; 21: 1983-92.

    23. Yusuf S, Teo KK, Pogue J, Dyal L, Copland I, Schumacher H, et al. Telmisartan,ramipril, or both in patients at high risk for vascular events. N Engl J Med 2008; 358:1547-59.

  • 50

    .. 2555

    1. . (OMRON)2. 3. () 4. () 5. () 6. - () 7. () 8. () 9. () 10. 11. () 12.

  • 51

  • 52

  • 53

  • 54

  • 55

  • 56