Clinical Hypertension

Question 1

What is the clinical definition of hypertension in the UK?

Answer 1

Systolic BP ≥ 140 mmHg and/or Diastolic BP ≥ 90 mmHg.

Question 2

What is pre-hypertension?

Answer 2

SBP 130–139 mmHg or DBP 80–89 mmHg.

Question 3

What is primary (essential) hypertension?

Answer 3

Hypertension with no identifiable cause, often linked to genetics or lifestyle.

Question 4

What is secondary hypertension?

Answer 4

Hypertension due to identifiable conditions like kidney, endocrine, or vascular disorders.

Question 5

List 5 risk factors for hypertension.

Answer 5

Obesity, poor diet, smoking, sedentary lifestyle, diabetes.

Question 6

What are 3 lifestyle interventions for hypertension?

Answer 6

DASH diet, regular exercise, weight management.

Question 7

What are 3 additional lifestyle tips for managing hypertension?

Answer 7

Limit alcohol, quit smoking, reduce stress.

Question 8

Name 3 classes of antihypertensive drugs.

Answer 8

ACE inhibitors, calcium channel blockers, beta-blockers/ARBs/diuretics.

Question 9

What is resistant hypertension?

Answer 9

Blood pressure remains high despite multiple antihypertensive drugs.

Question 10

How can periodontitis contribute to hypertension?

Answer 10

Via systemic inflammation (↑ IL-6, CRP), leading to endothelial dysfunction.

Question 11

What is the bacteremia pathway linking oral disease to hypertension?

Answer 11

Oral bacteria enter bloodstream (e.g., P. gingivalis), increasing inflammation and cytokines.

Question 12

How does the nitrate–nitrite–NO pathway affect BP?

Answer 12

Oral bacteria convert nitrate to NO, causing vasodilation and lowering BP.

Question 13

How can mouthwash affect blood pressure?

Answer 13

Chlorhexidine reduces nitrate-reducing bacteria, lowering NO and increasing BP.

Question 14

What oral side effects can Amlodipine cause?

Answer 14

Gingival enlargement and dry mouth.

Question 15

What oral side effect is linked to Ramipril?

Answer 15

Oral ulceration.

Question 16

Why should dentists be cautious with epinephrine in anaesthetics for hypertensive patients?

Answer 16

It may trigger cardiovascular events like arrhythmias or hypertensive crisis.

Question 17

Why is it important for dentists to review patient hypertension history?

Answer 17

Due to medication interactions, oral side effects, and potential cardiovascular complications.

Question 18

What is the link between oral health and cardiovascular disease?

Answer 18

Periodontitis increases systemic inflammation, contributing to hypertension and CVD.

Question 19

How can successful periodontal treatment affect BP?

Answer 19

It may reduce SBP and DBP, improving vascular health.

Question 20

How might dysbiosis of the oral microbiome influence hypertension?

Answer 20

It reduces nitrate-reducing bacteria, decreasing NO and raising BP.

Question 21

What oral bacteria are associated with nitrate reduction and BP control?

Answer 21

Veillonella, Actinomyces, Haemophilus, Neisseria.

Question 22

What inflammatory biomarkers link periodontitis to endothelial dysfunction?

Answer 22

CRP, IL-6, TNF-α.

Question 23

What oral bacterium is detected in atherosclerotic plaques and contributes to endothelial damage?

Answer 23

Porphyromonas gingivalis (P. gingivalis).

Question 24

What is the estimated global death toll related to CVD each year?

Answer 24

Approximately 17.9 million.

Question 25

What class of drugs used to treat hypertension blocks voltage-gated calcium channels?

Answer 25

Calcium channel blockers (e.g., Amlodipine).

Question 26

What is the role of ACE inhibitors in hypertension?

Answer 26

They prevent formation of angiotensin II, reducing vasoconstriction.

Question 27

A patient has BP of 145/95 mmHg and needs an extraction. What should the dentist do?

Answer 27

Proceed with caution; confirm it's not a hypertensive crisis. Use stress reduction, consider delaying if symptoms or history suggest instability.

Question 28

A hypertensive patient on amlodipine presents with gingival overgrowth. What is the dental management approach?

Answer 28

Improve oral hygiene, consider scaling, and refer to physician if medication substitution is needed.

Question 29

Why should NSAIDs be used with caution in hypertensive patients?

Answer 29

They may cause sodium retention and blunt antihypertensive effects, leading to increased BP.

Question 30

Why does periodontitis contribute to hypertension?

Answer 30

Chronic inflammation increases IL-6 and CRP, causing endothelial dysfunction and arterial stiffness.

Question 31

Why do ACE inhibitors cause a dry cough in some patients?

Answer 31

Due to bradykinin accumulation in the lungs, a result of ACE inhibition.

Question 32

Why should dentists avoid sudden epinephrine injections in hypertensive patients?

Answer 32

It may cause a spike in BP and risk of arrhythmia or cardiovascular event in compromised patients.