Hypertension Flashcards
1
Q
What is hypertension?
A
- abnormal elevation of arterial pressure: ≥120/80
- aka silent killer
- bc it has no warning signs or symptoms
- preventable in most cases
2
Q
Hypertension: Risk Factors
A
- Controllable-lower risk by changing these
- lifestyle
- diet
- exercise
- Uncontrollable
- Family hx
- age
3
Q
Hypertension: Epidemiology
A
- 77 million Americans
- 19% unaware
- 25% not under current treatment
- 48% treated, but not controlled
- Prevalence increases with age
- 50% of people >65 y.o. have HBP
-
Systolic rises throughout life
- diastolic levels off after 50 y.o.
- >90% of adults will develop HTN
- dental practice: ~500 people per 2,000 pts
4
Q
Physiology of Blood Pressure
A
- pressure against interior walls of arteries
- Korotkoff sounds
- sound produced by turbulent blood flow
- 1st sound=systolic pressure
- disappearance of sound=diastolic pressure
5
Q
Causes of Hypertension:
A
- 90-95% unknown
- called essential/primary hypertension
- 5-10%
- Obesity; Chronic Kidney disease; Coarctation of aorta
- Cushing syndrome; chronic steroid therapy; obstructive uropathy; Pheochromocytoma; Primary Aldosteronism
- Renovascular disease
- thyroid or parathyroid disease
- SLEEP APNEA
- Meds
- BC
- cold remedies
- de congestants
- OTC pain relievers
- some prescription drugs
- illegal drugs
- cocaine
- amphetamines
- Alcohol abuse or chronic alcohol use
6
Q
BP Categories
A
- Normal
- <120/80
- Elevated:
- Systolic: 120-129 & Diastolic: <80
- Stage 1:
- Systolic: 130-139 or diastolic: 80-89
- Stage 2:
- Systolic: 140+ and/or 90+
- Hypertensive crisis
- Systolic: 180+ and/or Diastolic >120
- change meds if no other indications of problems or immediate hospitalization if signs of organ damage
7
Q
New Guidelines Take aways
A
- prehypertension category- no longer exists
- replaced by elevated BP
- different numbers
- systolic and diastolic lower
- HBP=Systolic 130 or diastolic 80
- old 140/90
- HTN stage 1
- if systolic >130/80
- old=prehypertensive
- if systolic >130/80
- HTN stage 2:
- >140/90
- old=HTN stage 1
- >140/90
8
Q
When to prescribe medication for stage 1 hypertension
A
- Stage 1 HTN
- only if pt has :
- already had a cardio event
- heart attack or stroke
- high risk of heart attack or stroke based on age
- diabetes mellitus
- chronic kidney disease
- calculate atherosclerotic risk
- already had a cardio event
- only if pt has :
9
Q
What are the CVD risk factors in adults for HTN that we need to screen for and manage?
A
- Smoking
- Diabetes
- dyslipidemia
- excessive weight
- low fitness
- unhealthy diet
- psychosocial stress
- sleep apnea
10
Q
What are some basic tests for primary hypertension
A
- fasting blood glucose
- complete blood cell count (CBC count)
- basic metabolic panel
- thyroid stimulating hormone (TSH)
- urinalysis
- electrocardiogram w/optional echocardiogram
- uric acid
- urinary albumin to creatinine ratio
11
Q
What are the new recommendations for taking blood pressure?
A
- first visit
- record BP in both arms
- if >130/80, f/y w/PCP
- use higher reading arm for readings down the road
- Wait 1-2 min before repeating
- Give patient the BP reading written and verbally
- allow patient to rest for 5 mins prior to measuring BP
- average at least 2 readings over 2 visits
- should not determine if patient is hypertensive based on 1 BP measurement
12
Q
How do new guidelines impact dental professionals?
A
- Dental appointment
- more patients diagnosed w/HTN
- will see HTN drugs more frequently
- need to understand side effects of most common
- ex: Calcium Channel blockers
- amlodipine=Gingival hyperplasia
- educate pt about new guidelines
- more important role in screening for HTN bc patients see dentist more often
13
Q
What are the complications of undiagnosed or uncontrolled high BP?
A
- Aneurysms
- Chronic kidney disease
- Eye damage
- heart attack
- heart failure
- peripheral artery disease
- stroke
- vascular dementia
- Artherosclerosis
14
Q
Artherosclerosis
A
- thick and hard arteries
- leads to MI and/or stroke
15
Q
Aneurysm
A
- Weakened blood vessels that bulge
- Types:
- Saccular
- Fusiform
- Pseudoaneurysm
- Brain Aneurysm
- Cerebral Aneurysm
- ruptured=Hemorrhagic stroke
- Cerebral Aneurysm
16
Q
Chronic Kidney Disease
A
- Kidneys=filter XS fluid and waste from blood
- weak and narrow blood vessels in kidney
37
Q
Gingival Hyperplasia
A
- one of the most common side effects
- 3 types of drugs
- anticonvulsant
- phenytoin
- immunosuppressant
- cyclosporine A
- Calcium Channel Blockers
- Nifedipine
- verapamil
- diltiazem
- anticonvulsant
38
Q
Lichenoid Reaction
A
- one of the most common
- Antihypertensives:
- ACE inhibitors
- Beta Blockers
- nifedipine
- methyldopa
- Diuretics:
- hydrochlorothiazide
- frusemid
- spironolactone
- NSAID-rare
