Hypertension/Hypertensive Heart Diseases

Chapter 667

Cherrisa Pham – Paula Philpott – Armando Chavez

 Hypertension mean an abnormal elevation of arterial blood pressure, aka “silent killer.”
 It is a contributing risk factor in many vascular diseases and 1/3 of people who have
hypertension do not have symptoms.
 Early detection and knowledge of the health problems of patients is needed to ensure
treatment is safe and risk of emergencies.
 Persistent readings of high BP is considered to be at or above 140/90 mm Hg.

Occurrence
- Hypertensive disease affects 65 million Americans of the population in the U. S.
- Varies by age, race, education, etc.
- The disease affects more African Americans than any other race. More common in males
than in women, and usually begins at the age of 20 and older.
- Age (over 55 years for men, over 65 years for women)
- The newest at-risk populations for high blood pressure are children and adolescences.

Etiology
 Primary/Essential Hypertension (approximately 90%)
- Combinations of factors are more significant than any one alone.
EXAMPLES
- Tobacco use
- Hereditary
- Overweight
- Race
- Salt
- Sex
- Age
- Environment

 Secondary Hypertension (approximately 10%) – Secondary to other underlying medical

conditions. “Both systolic and diastolic blood pressures are elevated.”
EXAMPLES
- Oral Contraceptives
- Renal disease
- Endocrine disorders
- Medications
 CLASSIFICATION OF BLOOD PRESSURE
Table 67-1
Blood Pressure Systolic (mm Hg) Diastolic (mm
Category Hg)
Normal <120 <80
Prehypertension 120-139 80-89
Stage 1 Hypertension 140-159 90-99
Stage 2 Hypertension ≥160 ≥100

Signs and Symptoms

Severe Headaches Dizziness
Visual Disturbances Weakness
Tinnitus Tingling hands and feet
Sweating Loud heart sounds

Hypertensive Heart Disease

* Hypertensive Heart Disease is a condition caused by hypertension *
 It is the leading cause of death from high blood pressure.
 The heart working under increased pressure causes some different heart disorders.
 Hypertensive heart disease includes heart failure, thickening of the heart muscle,
coronary artery disease, and other conditions.
Emergencies
 Patients with hypertension are at risk of cardiovascular disease, “angina, stroke, arrhythmia,
and MI should all be anticipated as possible occurrence.”

White Coat Hypertension

 WCH refers to a persistently elevated office blood pressure in the presence of a normal
blood pressure outside of the office.
 Office BP is usually higher than BP measured out of the office, which has been ascribed to
the alerting response, anxiety, and/or a conditional response to the unusual situation.

Treatment and Goals of Hypertension

 There is no cure for hypertension but goals, medications, and lifestyle changes can
be addressed.
- Goals of maintaining diastolic pressure level below <80mm Hg
- Lower the risk of serious complications and death
- Control any underlying systemic disease
- Weight and exercise
- Diet
- Tobacco use
 Medications
Diuretics Beta – blockers ACE inhibitors
Calcium Channel Angiotensin Receptor Aldosterone Receptor
Blockers Blockers Blockers

Adverse Effects of Antihypertensive Drugs

Thiazide (Diuretics)  Xerostomia
Nifedipine (Calcium Channel Blocker)  Gingival Hyperplasia
Propranolol (Antihypertensive)  Oral Lichenoid Reaction
Acetazolamide (ACE inhibitors)  Dysgeusia/Ageusia
(cough & taste alteration)

Dental Considerations
** Special attention: any stressful procedure may increase BP and trigger acute
complications.** examples  CNS, Ophthalmic, CVS, and Endocrine.

o Indications/Contraindications (benefit must outweigh the risk)***

- Vasoconstrictor usage: Uncontrolled hypertension avoid all dental procedures.
- If controlled; limit the amount of vasoconstrictor
- Best Choice: Plain local anesthetic, 1:200,000 epinephrine concentrations; 2%
mepivacaine Hcl
o Most antihypertensive drugs have drug interactions with LA (local anesthetic) and
analgesics.
o Interaction of LA with nonselective beta-blockers may increase LA toxicity.
o The cardiovascular effects of epinephrine used during dental procedures may be
potentiated by the use of medications such as nonselective b-blockers (propranolol and
nadolol).
o Long-term use of NSAIDs may antagonize the antihypertensive effect of diuretics,
beta-blockers, alpha blockers, vasodilators, ACE inhibitors.
o Short-term administration has, however, a clinically meaningful effect. Other pain
relievers such as paracetamol can be used to avoid this side effect.

Periodontal Management
o Update Medical/Dental history
o Assess vital signs at every recall appointment
o Obtain accurate/routinely blood pressure measurements
o Monitor plaque/bleeding score due to several oral complication

Expected and Accepted Treatment options for Hypertension

o Recall: 3-6 Months (varies)
o Appointment Length
o Long and Stressful appointments should be avoided; short morning
appointments are best tolerated – STRESS REDUCTION PROTOCOLS.
 o Patient Positioning
o Supine Position
o After supine positioning, have the patient sit upright for at least 2 minutes before
standing to avoid orthostatic hypotension
o Pre-med – Advise patients to take medication as they normally would
o There is NO premedication for dental treatment however, oral premedication can
be considered to reduce anxiety
o Ex: Triazolam. A dose at bedtime the night before and another dose 1 hour prior
to the dental appointment.
o Patient Education
o Encourage effective oral hygiene to prevent soft tissue inflammation
o Use caution with oral aids to prevent injury
o Home care instructions for xerostomia
 Alcohol mouth rinses
 Chew sugarless gum
 Frequent sips of water
 Saliva substitutes
 Use daily home fluoride

Questions
1. What is considered stage 1 hypertension?
a. 160>108
b. 123>99
c. 133>88
d. 100>72
e. None of the above
2. Which medications are not used to treat hypertension?
a. Metoprolol
b. Lisinopril
c. Propranolol
d. Cyclosporine
e. all of the above
3. What is the best patient chair positioning?
a. Supine
b. Semi-Supine
c. Upright
d. Trendelenburg
e. A and B
4. Which are not adverse effects of antihypertensive drugs?
a. Oral Lichenoid Reaction
b. Gingival Hyperplasia
c. Exophthalmos
d. Xerostomia
e. Dysgeusia