2024 Thai guidelines on the treatment of hypertension

Abstract

The committee of the 2024 Thai Guidelines on the Treatment of Hypertension has reviewed new developments in the body of knowledge, combined with expertise in real-life clinical practice and evidence collected from clinical studies worldwide. The Guidelines consist of newly highlighted key topics to be up to date and suitable for the country’s context. We still maintained the current office blood pressure (BP) cut-point of 140/90 mmHg for hypertension diagnosis. The new BP category, “BP at risk,” i.e., BP of 130–139/80–89 mmHg, was introduced. The out-of-office BP measurements, including home BP monitoring (HBPM) or ambulatory blood pressure monitoring (ABPM), are also advocated to confirm the diagnosis of hypertension. Target BP levels depend on the age of the patients i.e., 120–130/70–79 mmHg for patients age 18–65 years, 130–139/70–79 mmHg for patients over 65 years of age. There are 5 main groups of antihypertensive medication, that is, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, calcium-channel blockers, and diuretics (thiazides and thiazide-like diuretics such as chlorthalidone and indapamide). Two types of medications should be started for most patients, except for frail elderly patients, patients with relatively low initial BP (140–149/90–99 mmHg), and low-risk patients; only 1 type of starting medication should be selected. Medication that is a combination of 2 types in 1 pill should be selected. Patient empowerment can be useful in sharing decisions in goal setting, provision of feedback channels, self-monitoring, education, and motivation, which the use of telemedicine and mobile health technologies can assist.