Normal \ 120 change meds if no other indications of problems or immediate hospitalization if signs of organ damage

thick and hard arteries leads to MI and/or stroke

Weakened blood vessels that bulge Types: Saccular Fusiform Pseudoaneurysm Brain Aneurysm Cerebral Aneurysm ruptured=Hemorrhagic stroke

Hypertension Flashcards by Connor Schmidt

What is hypertension?

abnormal elevation of arterial pressure: ≥120/80
aka silent killer
- bc it has no warning signs or symptoms
preventable in most cases

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Hypertension: Risk Factors

Controllable-lower risk by changing these
- lifestyle
- diet
- exercise
Uncontrollable
- Family hx
- age

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Hypertension: Epidemiology

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

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Physiology of Blood Pressure

pressure against interior walls of arteries
Korotkoff sounds
- sound produced by turbulent blood flow
1st sound=systolic pressure
disappearance of sound=diastolic pressure

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Causes of Hypertension:

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

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BP Categories

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

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New Guidelines Take aways

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
HTN stage 2:
- >140/90
  - old=HTN stage 1

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When to prescribe medication for stage 1 hypertension

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

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What are the CVD risk factors in adults for HTN that we need to screen for and manage?

Smoking
Diabetes
dyslipidemia
excessive weight
low fitness
unhealthy diet
psychosocial stress
sleep apnea

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What are some basic tests for primary hypertension

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

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What are the new recommendations for taking blood pressure?

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

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How do new guidelines impact dental professionals?

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

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What are the complications of undiagnosed or uncontrolled high BP?

Aneurysms
Chronic kidney disease
Eye damage
heart attack
heart failure
peripheral artery disease
stroke
vascular dementia
Artherosclerosis

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Artherosclerosis

thick and hard arteries
leads to MI and/or stroke

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Aneurysm

Weakened blood vessels that bulge
Types:
- Saccular
- Fusiform
- Pseudoaneurysm
Brain Aneurysm
- Cerebral Aneurysm
  - ruptured=Hemorrhagic stroke

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Chronic Kidney Disease

Kidneys=filter XS fluid and waste from blood
weak and narrow blood vessels in kidney

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Damage to kidney: Types

Kidney failure
Kidney Scarring (Glomerulosclerosis)
Kidney Artery Aneurysm

Kidney Disease

HTN one of the most common causes
damages larger arteries leading to your kidney and tiny blood vessels (glomeruli) in the kidney
can’t filter waste from blood→accumulates
require dialysis or kidney transplant

Kidney Scarring

aka Glomerulosclerosis
glomeruli scarred
- tiny blood vessels in kidney
can’t filter waste
leads to kidney failure

Damage to brain: types

Transient Ischemic Attack (TIA)
Stroke
Dementia
Mild Cognitive impairment

Transient Ischemic Attack

caused by atherosclerosis or blood clot
warning that you’re at risk of a stroke

Stroke

occurs when part of brain is deprived of oxygen and nutrients
causes brain cells to die
uncontrolled HBP damages and weakens brains blood vessel-→stroke

Dementia

Brain disease
problems with:
- thinking
- speaking
- reasoning
- movement

HTN: Treatment goals

<60 y.o., Diabetes, Chronic Kidney Disease
- BP <120/80
>60 y.o.
- <150/90
- recommend home monitoring

Non-Medicine Treatment options for HTN:

* Life style changes * age & condition based criteria * Weight loss if overweight: * adopt DASH eating plan * Dietary Approaches to Stop Hypertension * fruits * veggies * low fat dairy * reduced cholesterol, saturated and total fat * adequate potassium and calcium * Reduce sodium intake (\<2.4 g/day) \*\*\*\* * Regular aerobic physical activity * limit alcohol intake (\<1-2 drinks/day * stop smoking

HTN: Pharmacologic management-different types of drugs used

Common * Diuretics (thiazides) * Beta adrenergic blockers * Alpha Adrenergic blockers * Alpha-Beta Adrenergic blockers * ACE inhibitors (angiotensin converting enzyme) * Calcium Channel Blockers * ARBs (angiotensin II receptor blockers) Less frequently Used * Vasodilators * central alpha agonists

HTN Tx: Medication related concerns

* NSAIDs and Antihyptensive * Antibiotics & Calcium Channel Blocker=Fatal combo * increased risk of hospitalization for * acute kidney injury * hypotension * death

HTN: Common side effects of ACE inhibitors

* persistent dry cough * most common * dizziness * taste disturbance * rashes

HTN: Common side effects of ARBs

* Dizziness * Headache

HTN: Common side effects of Calcium Channel Blockers

* Flushed face * headaches * swollen ankles * dizziness * tired

HTN: Common side effects of Diuretics

* Frequent urination * dizziness * GI disturbance

HTN: Common side effects of Beta Blockers

* Tired * cold hands and feet * slow heartbeat * Nausea & diarrhea * Disturbed sleep * nightmares

HTN: Common side effects of Alpha Blockers

* Drowsiness * Hypotension * Postural hypotension * syncope * asthenia * dizzy * headache * dry mouth

HTN: Common side effects of Centrally acting antihypertensive drugs

* Headache * Dizzy * Dry mouth

HTN: Common side effects of Vasodilator

* Headache * Nausea * vomiting * Tachycardia

What are the most common side effects of antihypertensive drugs on the oral cavity?

* Gingival Hyperplasia * Lichenoid Reaction * Dry mouth

Gingival Hyperplasia

* one of the most common side effects * 3 types of drugs * anticonvulsant * phenytoin * immunosuppressant * cyclosporine A * Calcium Channel Blockers * Nifedipine * verapamil * diltiazem

Lichenoid Reaction

* one of the most common * Antihypertensives: * ACE inhibitors * Beta Blockers * nifedipine * methyldopa * Diuretics: * hydrochlorothiazide * frusemid * spironolactone * NSAID-rare

HTN & Dental Treatment: When should elective dental procedures not be done?

BP ≥180/110

HTN & Dental Treatment: When should needed dental treatment not be done?

* Elective: * deferred if BP ≥180/110 * Needed treatment: * decision made on case to case basis * comorbid factors & symptoms * systolic: 150-180 * Diastolic: 100-120 * Hypertensive emergency/ Malignant Hypertension * Severe HTN w/sytolic\>180 w/ evidence of organ damage * recommend go to ER or physician that day

HTN: Summary points

* any level ofHTN is associated with increased risk of CVD * remain asymptomatic for long periods * many patients are unaware-ask for comorbid conditions * diabetes * renal disease * many patients are noncompliant w/meds-→not controlled * Local anesthesia w/epinephrine used w/little risk * _Non-selective beta blocker_-use cautiously * may cause hypertensive rxns * max of 2 carpules * Betapace * Blocadren * Corgard * _Cardioselective Beta Blocker_-do not cause HTN rxns (-olol) * acetolol * atenolol * betaxolol * bisoprolol * esmolol * metoprolol

What is the risk of providing dental tx to patients with hypertension?

Low