Hypertension Flashcards
incidence
65 million adults, 50% of those >65 yo
pathophysiology
- chronic elevation in arterial blood pressure
- asymptomatic damage to delicate lining
primary vs secondary etiology
primary - unknown cause
secondary - environment/genes
which type of etiology is the majority of htn cases?
primary (90%)
what happens if fat and calcium builds up in your arteries?
plaque stiffens and narrows the artery
normal BP
<120 AND <80
treatment for normal BP
follow-up in 2 years
elevated BP
120-129 AND <80
treatment for elevated BP
lifestyle mod
stage 1 htn
130-139 OR 80-89
treatment for stage 1 htn
drugs and lifestyle
stage 2 htn
≥140 OR ≥90
treatment for stage 2 htn
drugs and lifestyle
what are some lifestyle modifications?
- 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
BP goal
≤130/80
stage 1 htn drug therapy
- single drug therapy
- titrate and/or addition of another drug when necessary
stage 2 htn drug therapy
- combo drug therapy of different classes
- ACE inhibitors
- angiotensin receptor blockers
- thiazide diuretics
- Ca channel blockers
which class of htn drug is generally prescribed first in stage 2 drug therapy?
diuretics
htn targets which organs?
- kidneys
- heart
- brain
aggressive therapy decreases the risk of stroke by what percent in hypertensive pts?
30-40
aggressive therapy decreases the risk of MI by what percent in hypertensive pts?
20-25%
aggressive therapy decreases the risk of heart failure by by what percent in hypertensive pts?
> 50%
hypertensive emergency
sudden, acute elevation of BP (≥180 and/or ≥120) with possibility of serious CV outcome
endogenous catecholamines
stress/anxiety
exogenous catecholamines
- local with vasoconstrictor
- gingival retraction cord with vasoconstrictor
MAJOR risk factors imposed by presence of CV disease
- unstable coronary syndromes
- decompensated heart failure
- significant arrhythmias
- severe valvular disease
INTERMEDIATE risk factors imposed by presence of CV disease
- history of ischemic disease
- history of compensated heart failure
- history of cerebrovascular disease
- diabetes mellitus
- renal insufficiency
MINOR risk factors imposed by presence of CV disease
- advanced age (>70 yo)
- abnormal ECG
- rhythm other than sinus
- uncontrolled systemic htn (>180/110)
HIGH risk procedures (>5%)
- aortic/major vascular surgery
- peripheral vascular surgery
INTERMEDIATE risk procedures (<5%)
- intraperitoneal/intrathoracic surgery
- carotid endarterectomy
- head and neck surgery
- orthopedic surgery
- prostate surgery
LOW risk procedures (<1%)
- endoscopic procedures
- superficial procedures
- cataract surgery
- breast surgery
- ambulatory surgery
dental procedures impose what type of risk?
considered superficial procedure so low risk (<1%)
functional capacity
ability to engage in normal physical activity without syms
METs
metabolic equivalents of tasks
*are you able to climb a flight of stairs without having chest discomfort or shortness of breath?
should you treat METs > 4?
yes
should you treat METs <4?
no
should you proceed with dental care if pt’s BP is <160/100?
yes
*no referral necessary
should you proceed with dental care if pt’s BP is ≥160/100 but <180/110?
yes but with caution; consider BP monitoring
what would be your recommendation if pt’s BP is ≥160/100 but <180/110?
see PCP within 1 mo
should you proceed with dental care if pt’s BP is ≥180/110?
defer elective treatment
what would be your recommendation if pt’s BP is ≥180/110 and asymptomatic?
to PCP within 1 wk
what would be your recommendation if pt’s BP is ≥180/110 and symptomatic and/or diastolic >120?
immediate evaluation (send to ER)
mods to dental txt
- 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
what is considered modest dose of epi?
1-2 carts 2% lido w/ 1:100k epi
