Hypertension

Question 1

incidence

Answer 1

65 million adults, 50% of those >65 yo

Question 2

pathophysiology

Answer 2

• chronic elevation in arterial blood pressure

- asymptomatic damage to delicate lining

Question 3

primary vs secondary etiology

Answer 3

primary - unknown cause

secondary - environment/genes

Question 4

which type of etiology is the majority of htn cases?

Answer 4

primary (90%)

Question 5

what happens if fat and calcium builds up in your arteries?

Answer 5

plaque stiffens and narrows the artery

Question 6

normal BP

Answer 6

<120 AND <80

Question 7

treatment for normal BP

Answer 7

follow-up in 2 years

Question 8

elevated BP

Answer 8

120-129 AND <80

Question 9

treatment for elevated BP

Answer 9

lifestyle mod

Question 10

stage 1 htn

Answer 10

130-139 OR 80-89

Question 11

treatment for stage 1 htn

Answer 11

drugs and lifestyle

Question 12

stage 2 htn

Answer 12

≥140 OR ≥90

Question 13

treatment for stage 2 htn

Answer 13

drugs and lifestyle

Question 14

what are some lifestyle modifications?

Answer 14

• weight loss in overweight/obese pts
• smoking cessation
• control blood glucose and lipids
• heart healthy foods, decreased sodium, potassium supplementation
• moderate alcohol
• structured physical activity program

Question 15

BP goal

Answer 15

≤130/80

Question 16

stage 1 htn drug therapy

Answer 16

• single drug therapy

- titrate and/or addition of another drug when necessary

Question 17

stage 2 htn drug therapy

Answer 17

• combo drug therapy of different classes
• ACE inhibitors
• angiotensin receptor blockers
• thiazide diuretics
• Ca channel blockers

Question 18

which class of htn drug is generally prescribed first in stage 2 drug therapy?

Answer 18

diuretics

Question 19

htn targets which organs?

Answer 19

• kidneys
• heart
• brain

Question 20

aggressive therapy decreases the risk of stroke by what percent in hypertensive pts?

Answer 20

30-40

Question 21

aggressive therapy decreases the risk of MI by what percent in hypertensive pts?

Answer 21

20-25%

Question 22

aggressive therapy decreases the risk of heart failure by by what percent in hypertensive pts?

Answer 22

> 50%

Question 23

hypertensive emergency

Answer 23

sudden, acute elevation of BP (≥180 and/or ≥120) with possibility of serious CV outcome

Question 24

endogenous catecholamines

Answer 24

stress/anxiety

Question 25

exogenous catecholamines

Answer 25

- local with vasoconstrictor | - gingival retraction cord with vasoconstrictor

Question 26

MAJOR risk factors imposed by presence of CV disease

Answer 26

- unstable coronary syndromes - decompensated heart failure - significant arrhythmias - severe valvular disease

Question 27

INTERMEDIATE risk factors imposed by presence of CV disease

Answer 27

- history of ischemic disease - history of compensated heart failure - history of cerebrovascular disease - diabetes mellitus - renal insufficiency

Question 28

MINOR risk factors imposed by presence of CV disease

Answer 28

- advanced age (>70 yo) - abnormal ECG - rhythm other than sinus - uncontrolled systemic htn (>180/110)

Question 29

HIGH risk procedures (>5%)

Answer 29

- aortic/major vascular surgery | - peripheral vascular surgery

Question 30

INTERMEDIATE risk procedures (<5%)

Answer 30

- intraperitoneal/intrathoracic surgery - carotid endarterectomy - head and neck surgery - orthopedic surgery - prostate surgery

Question 31

LOW risk procedures (<1%)

Answer 31

- endoscopic procedures - superficial procedures - cataract surgery - breast surgery - ambulatory surgery

Question 32

dental procedures impose what type of risk?

Answer 32

considered superficial procedure so low risk (<1%)

Question 33

functional capacity

Answer 33

ability to engage in normal physical activity without syms

Question 34

METs

Answer 34

metabolic equivalents of tasks *are you able to climb a flight of stairs without having chest discomfort or shortness of breath?

Question 35

should you treat METs > 4?

Answer 35

yes

Question 36

should you treat METs <4?

Answer 36

no

Question 37

should you proceed with dental care if pt's BP is <160/100?

Answer 37

yes *no referral necessary

Question 38

should you proceed with dental care if pt's BP is ≥160/100 but <180/110?

Answer 38

yes but with caution; consider BP monitoring

Question 39

what would be your recommendation if pt's BP is ≥160/100 but <180/110?

Answer 39

see PCP within 1 mo

Question 40

should you proceed with dental care if pt's BP is ≥180/110?

Answer 40

defer elective treatment

Question 41

what would be your recommendation if pt's BP is ≥180/110 and asymptomatic?

Answer 41

to PCP within 1 wk

Question 42

what would be your recommendation if pt's BP is ≥180/110 and symptomatic and/or diastolic >120?

Answer 42

immediate evaluation (send to ER)

Question 43

mods to dental txt

Answer 43

- good pain and anxiety control - short apts - give nitrous oxide - give local with modest doses of epi - avoid retraction cord with epi - slow chair repositioning - check ePocrates for potential drug interactions

Question 44

what is considered modest dose of epi?

Answer 44

1-2 carts 2% lido w/ 1:100k epi