ELFH - cardiac challenges for dental practitioner Flashcards
What is often quoted as being ‘high’ BP?
consistent reading over 140/90mmhg
What time period should BP be measured over?
over a period of time
eg 7 days of home readings
essential hypertension?
In 80% to 90% of patients with hypertension, the cause is unknown. This is termed ‘essential hypertension’.
What factors are thought to be implicated in the development of essential hypertension?
obesity
alcohol
salt intake
stress
genetics
Secondary hypertension?
In 10% to 20% of patients, high BP is due to a number of rarer causes
What are the causes of secondary hypertension?
usually kidney dysfunction and hormonal disturbances (Cushing’s syndrome, Conn’s syndrome, phaechromocytoma)
Congenital cardiovascular disease (for example, coarctation of the aorta)
drugs (for example, oral contraceptive pill, steroids)
pregnancy are also implicated.
These cases are known as ‘secondary hypertension’.
isolated systolic hypertension?
The term ‘isolated systolic hypertension’ is associated with increasing age and with hyperthyroidism.
What is the pathogenesis of essential hypertension?
unclear
felt that changes in the sensitivity of specialised pressure receptors within blood vessels (baroreceptors) are involved.
These changes seem to lead to patients tolerating higher BPs than normal.
Longstanding hypertension affects?
arteries
heart muscle
kidneys and eyes
Effect of longstanding hypertension in small arteries and arterioles?
thicker walls and smaller lumens leading to increased total peripheral resistance
Effect of longstanding hypertension in larger arteries?
there is an increase in collagen and occasionally calcium deposition, which also increases total peripheral resistance
What is the risk of longstanding hypertension in arteries?
hypertension is a significant risk factor for the development of atherosclerosis, raising the risk of myocardial infarction and strokes.
What is the effect of longstanding hypertension to heart muscle?
results in an increase in the size of the heart muscle due to hypertrophic cardiac cell changes
This arises as the heart has to work harder to eject blood against the increased resistance.
This has implications for heart function and can predispose to the development of significant heart disease.
Effect of longstanding hypertension in the kidneys and eyes?
hypertension can also lead to damage to the microcirculation of the kidneys and to the eyes, resulting in kidney failure and visual impairment.
When is management of BP undertaken?
after an individual’s risk for cardiovascular disease has been ascertained.
What is the initial advise when a pt has been ascertained as being at risk of cardiovascular disease?
weight loss
low salt diet
moderation of alcohol intake
BP for hypertension?
> 180/120mmHg
Management of hypertension? (NICE)
treat urgently, assess for target organ damage and remeasure BP 7 days
BP for hypertension and CV risk?
140/90 to 179/119mmHg
BP for borderline hypertension and low risk CV risk?
Under 140/90mmHg over 120/80 mmHg
For hypertensive patients aged 55 or older, or pts of African and Caribbean descent of any age, what is the 1st choice for initial therapy?
should be either a calcium channel blocker (for example, amlodipine)
or a thiazide-type diuretic (for example, bendroflumethiazide).
For hypertensive pts younger than 55, what is the first choice of therapy?
an angiotensin-converting enzyme (ACE) inhibitor (for example, ramipril).
What is used if ACE inhibitors are not tolerated?
angiotensin II receptor antagonists (for example, losartan) can be used.
What are potential effects of antihypertensive drugs?
postural hypotension
xerostomia
gingival overgrowth
