Hypertension Flashcards
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
Hypertension: Risk Factors
- Controllable-lower risk by changing these
- lifestyle
- diet
- exercise
- Uncontrollable
- Family hx
- age
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
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
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
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
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
- if systolic >130/80
- HTN stage 2:
- >140/90
- old=HTN stage 1
- >140/90
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
- already had a cardio event
- only if pt has :
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
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
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
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
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
Artherosclerosis
- thick and hard arteries
- leads to MI and/or stroke
Aneurysm
- Weakened blood vessels that bulge
- Types:
- Saccular
- Fusiform
- Pseudoaneurysm
- Brain Aneurysm
- Cerebral Aneurysm
- ruptured=Hemorrhagic stroke
- Cerebral Aneurysm
Chronic Kidney Disease
- Kidneys=filter XS fluid and waste from blood
- weak and narrow blood vessels in kidney
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
- Dietary Approaches to Stop Hypertension
- Reduce sodium intake (<2.4 g/day) ****
- Regular aerobic physical activity
- limit alcohol intake (<1-2 drinks/day
- stop smoking
- adopt DASH eating plan
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
- increased risk of hospitalization for
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
- anticonvulsant
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
- decision made on case to case basis
- 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 unaware-ask for comorbid conditions
- 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
-
Non-selective beta blocker-use cautiously
What is the risk of providing dental tx to patients with hypertension?
Low