Hypertension

Question 1

HTN is an abnormal elevation in ___ pressure and the most common diagnosis in US.

Answer 1

arterial

65 million adults
1/2 of patients >65yo

Question 2

What are the early vs advanced signs of HTN?

Answer 2

early: elevated BP reading
advanced: severely elevated BP involving target organ

Question 3

How is HTN diagnosed?

Answer 3

1. critical to have BP measured at PCP appointments as often undetected
2. 2 or more readings over 2 or more office visits
3. rule out identifiable causes

Question 4

less than 120 / less than 80

Answer 4

normal BP (treatment: follow-up in 2 yrs)

Question 5

120-139/80-90

Answer 5

Prehypertension (treatment: lifestyle mod)

Question 6

140-159/90-99

Answer 6

Stage 1 HTN (treatment: drugs)

Question 7

> 160 / >100

Answer 7

Stage 2 HTN (treatment: drugs)

Question 8

What is the goal of drug therapy for HTN? What if the patient is diabetic or has kidney disease?

Answer 8

less than 140/90

If diabetics or kidney disease, less than 130/80

Question 9

What is the drug therapy of choice?

Answer 9

thiazide

Question 10

___ damage occurs in target organs while disease is “silent”.

Answer 10

Vascular

Question 11

Match the morbidity of untreated HTN

1. 50%
2. 33%
3. 10-15%

A. Stroke
B. Renal failure
C. CAD, CHF

Answer 11

1 - C
2 - A
3 - B

Question 12

What are some follow-up questions we can ask?

Answer 12

1. date of diagnosis
2. typical reading
3. treatment recommendation and compliance
4. recent changes in prescribed medications
5. ever been treated in the ED for symptoms, secondary to elevated BP (HA, dizziness, disorientation, blurred vision)
6. functional status

Question 13

What is the potential problem in dentistry for HTN patients?

Answer 13

• 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

Question 14

T/F. Dentistry is a low risk for perioperative CV event.

Answer 14

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

Question 15

What is the dental treatment recommendations and PCP follow-up recommendations for ≤120/80?

Answer 15

Any required

No referral necessary

Question 16

What is the dental treatment recommendations and PCP follow-up recommendations for ≥120/80 but less than 140/90?

Answer 16

any required

encourage patient to F/U

Question 17

What is the dental treatment recommendations and PCP follow-up recommendations for ≥140/90 but less than 160/100?

Answer 17

any required

encourage patient to F/U

Question 18

What is the dental treatment recommendations and PCP follow-up recommendations for ≥160/100 but less than 180/110?

Answer 18

any required; consider monitoring

refer within 1 month

Question 19

What is the dental treatment recommendations and PCP follow-up recommendations for ≥180/110?

Answer 19

defer elective treatment; noninvasive emergency care

asymptomatic - to PCP
symptomatic - to ED

Question 20

What are the target organ symptoms to the brain, eyes and heart?

Answer 20

brain: HA, dizziness, disorientation
eyes: blurry vision
heart: angina, SOB

Question 21

What dental treatment modifications are taken with HTN patients?

Answer 21

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

Question 22

Patients on non-selective beta blockers can have severe hypertension and bradycardia if given ___.

Answer 22

Epinephrine

Question 23

What drug can decrease the efficacy of antihypertensives?

Answer 23

NSAIDs (prescribe for minimal days)