Treatment steps for hypertension

ေသြးတိုး ကုထံုး
ကုနညး္
Treatment steps for hypertension
ေသြးတုိးကို အဆင့္ သံုးမ်ိ ုးခြဲထားတယ္
Stage 1 hypertension Clinic blood pressure is 140/90 mmHg or higher and subsequent ambulatory blood pressure monitoring (ABPM) daytime average or home blood pressure monitoring (HBPM) average blood pressure is 135/85 mmHg or higher.
ပထမ အဆင့္က  ၁၄၀ ၉၀ ေလာက္ကို stage1 hypertension ေပါ့

Stage 2 hypertension Clinic blood pressure is 160/100 mmHg or higher and subsequent ABPM daytime average or HBPM average blood pressure is 150/95 mmHg or higher.
stage 2 ဆို၇င္   160/100  ေရွ့ ၂၀ ေနာက္ ၁၀ ေပါင္း

Severe hypertension Clinic systolic blood pressure is 180 mmHg or higher or clinic diastolic blood pressure is 110 mmHg or higher.
severe ဆို၇င္ ၁၈၀ ၁၁၀ အထက္
သံုး မ်ိ ုး ပိုင္း ထားတယ္
stage 1 stage2 servere ေပါ့  140/90  160/100 180/110

ကု သနညး္မ်ား
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Lifestyle interventions
ပံုမွန္ ေလ့က်င့္ခန္း လုပ္
အငန္ ေရွာင္
Discourage excessive consumption of coffee and other caffeine-rich products  ေက္ာဖိေရွာင္
Do not offer calcium, magnesium or potassium supplements as a method for reducing blood pressure
အရက္ေလွ ်ာ ့ ေသာက္

Step 1 treatment
under 55 years
an angiotensin-converting enzyme (ACE) inhibitor or a low-cost angiotensin-II receptor blocker (ARB)
Do not combine an ACE inhibitor with an ARB to treat hypertension  နစ္ခု ေပါငး္ မေပးရ

over 55 years
calcium-channel blocker (CCB)
oedema or intolerance ၇ိွရင္ မေပးရ
offer a thiazide-like diuretic ေျပာငး္ ေပး
chlortalidone (12.5–25.0 mg once daily) or
 indapamide (1.5 mg modified-release once daily or 2.5 mg once daily) in preference to a conventional thiazide diuretic such as bendroflumethiazide or hydrochlorothiazide.

Beta-blockers are not a preferred initial therapy for hypertension. However, beta-blockers may be considered in younger people, particularly:
Beta-blockers ေသြးတိုး မွာ စစ ၿခင္း ေပးေလ့ မ၇ိွၾကဘူး လူငယ္ေတြကို ေပး
    those with an intolerance or contraindication to ACE inhibitors and angiotensin II receptor antagonists or
acei rblocker ေတြ နဲ့ မတည့္သူေတြ တို့
    women of child-bearing potential or  ကိုယ္ ၀န္ ေဆာင္သယ္တို့

    people with evidence of increased sympathetic drive
If therapy is initiated with a beta-blocker and a second drug is required, add a calcium-channel blocker rather than a thiazide-like diuretic to reduce the person's risk of developing diabetes
beta-blocker  ေပးျပီးဆိုရင္လညး္ ccb နဲ့ တြဲ ေပး

Step 2 treatment
a CCB in combination with either an ACE inhibitor or an ARB
If a CCB is not suitable for step 2 treatment, for example because of oedema or intolerance, or if there is evidence of heart failure or a high risk of heart failure, offer a thiazide-like diuretic 
ccb နဲ့ အဆင္မေျပရင္ diuretic ေျပာငး္ ေပး

Step 3 treatment
Before considering step 3 treatment, review medication to ensure step 2 treatment is at optimal or best tolerated doses
the combination of ACE inhibitor or angiotensin II receptor blocker, calcium-channel blocker and thiazide-like diuretic should be used

Step 4 treatment
Regard clinic blood pressure that remains higher than 140/90 mmHg after treatment with the optimal or best tolerated doses of an ACE inhibitor or an ARB plus a CCB plus a diuretic as resistant hypertension, and consider adding a fourth antihypertensive drug and/or seeking expert advice.

For treatment of resistant hypertension at step 4:

    Consider further diuretic therapy with low-dose spironolactone (25 mg once daily)[8] if the blood potassium level is 4.5 mmol/l or lower. Use particular caution in people with a reduced estimated glomerular filtration rate because they have an increased risk of hyperkalaemia.

    Consider higher-dose thiazide-like diuretic treatment if the blood potassium level is higher than 4.5 mmol/l.


https://www.nice.org.uk/guidance/cg127/chapter/1-Guidance#measuring-blood-pressure
https://www.nice.org.uk/guidance/CG127
https://pathways.nice.org.uk/pathways/hypertension/hypertension-overview#path=view%3A/pathways/hypertension/management-of-hypertension.xml&content=view-index
https://pathways.nice.org.uk/pathways/hypertension/hypertension-overview#path=view%3A/pathways/hypertension/treatment-steps-for-hypertension.xml&content=view-index
https://pathways.nice.org.uk/pathways/hypertension/hypertension-overview#content=view-node%3Anodes-step-2&path=view%3A/pathways/hypertension/treatment-steps-for-hypertension.xml