Hypertension Flashcards
HTN is an abnormal elevation in ___ pressure and the most common diagnosis in US.
arterial
65 million adults
1/2 of patients >65yo
What are the early vs advanced signs of HTN?
early: elevated BP reading
advanced: severely elevated BP involving target organ
How is HTN diagnosed?
- critical to have BP measured at PCP appointments as often undetected
- 2 or more readings over 2 or more office visits
- rule out identifiable causes
less than 120 / less than 80
normal BP (treatment: follow-up in 2 yrs)
120-139/80-90
Prehypertension (treatment: lifestyle mod)
140-159/90-99
Stage 1 HTN (treatment: drugs)
> 160 / >100
Stage 2 HTN (treatment: drugs)
What is the goal of drug therapy for HTN? What if the patient is diabetic or has kidney disease?
less than 140/90
If diabetics or kidney disease, less than 130/80
What is the drug therapy of choice?
thiazide
___ damage occurs in target organs while disease is “silent”.
Vascular
Match the morbidity of untreated HTN
- 50%
- 33%
- 10-15%
A. Stroke
B. Renal failure
C. CAD, CHF
1 - C
2 - A
3 - B
What are some follow-up questions we can ask?
- date of diagnosis
- typical reading
- treatment recommendation and compliance
- recent changes in prescribed medications
- ever been treated in the ED for symptoms, secondary to elevated BP (HA, dizziness, disorientation, blurred vision)
- functional status
What is the potential problem in dentistry for HTN patients?
- stress and anxiety release endogenous catecholamines
- injection of exogenous catecholamines with LA vasoconstrictors
- absorption of vasoconstrictors from ginigival retraction cord
- sudden, acute elevation in BP leading to serious outcome
T/F. Dentistry is a low risk for perioperative CV event.
True, risk is based on severity of patient’s disease.
Procedure is superificia (non-surgical dental or minor oral/perio surgery)
Some OMS procedures are intermediate risks
What is the dental treatment recommendations and PCP follow-up recommendations for ≤120/80?
Any required
No referral necessary
What is the dental treatment recommendations and PCP follow-up recommendations for ≥120/80 but less than 140/90?
any required
encourage patient to F/U
What is the dental treatment recommendations and PCP follow-up recommendations for ≥140/90 but less than 160/100?
any required
encourage patient to F/U
What is the dental treatment recommendations and PCP follow-up recommendations for ≥160/100 but less than 180/110?
any required; consider monitoring
refer within 1 month
What is the dental treatment recommendations and PCP follow-up recommendations for ≥180/110?
defer elective treatment; noninvasive emergency care
asymptomatic - to PCP
symptomatic - to ED
What are the target organ symptoms to the brain, eyes and heart?
brain: HA, dizziness, disorientation
eyes: blurry vision
heart: angina, SOB
What dental treatment modifications are taken with HTN patients?
stress management (short, morning appointments; nitrous oxide) profound LA with modest doses of epi (40mcg) avoid ginigival retraction cord with epi slow chair repositioning potential drug interactions
Patients on non-selective beta blockers can have severe hypertension and bradycardia if given ___.
Epinephrine
What drug can decrease the efficacy of antihypertensives?
NSAIDs (prescribe for minimal days)
