Hypertension

Question 1

List three risk factors for hypertension. (3)

Answer 1

Age, family history, overweight, physical activity, tobacco, too much sodium, not enough potassium, alcohol

Question 2

How do we measure routinely the blood pressure? What are the two blood pressures? Which one is usually lower? What do they represent? (3)

Answer 2

sphygmomanometer/blood pressure meter.

1. Systolic measure the pressure in the arteries during heart beat (when muscle contract) (120)
2. Diastolic measure the pressure in the arteries between heartbeats (when heart muscles is resting between beats and refilling with blood) (80)

Question 3

Write down at least two harmful consequences of hypertension apart from CVA. (2)

Answer 3

Renal failure / myocardial infarction / retinopathy / aneurysm (rupture of vessel lead to internal bleeding)

Question 4

What is the main cause of CVA? (1) (Cerebrovascular accident = stroke)

Answer 4

CVA = Cerebrovascular accident = stroke

Causes of strokes include

ischemia (loss of blood supply) or hemorrhage (bleeding) in the brain.

Note: People at risk for stroke include those who have high blood pressure, high cholesterol, diabetes, and those who smoke. People with heart rhythm disturbances, especially atrial fibrillation are also at risk.

Question 5

What is the mechanism of CVA?

Answer 5

Mechanism

• By obstruction of artery supplying the brain-like atherosclerosis, fatty plaque deposition on vessel wall
• Life style behavioural (high cholesterol diet, insufficient exercises) / medical(DM)/ other factors (ageing)

Question 6

What is the cause of cerebrovascular perfusion? (1)

Answer 6

Cerebral perfusion pressure, net pressure gradient gradient causing cerebral blood flow to the brain.

It must be maintained within narrow limits because too little pressure could cause brain tissue to become ischemic (having inadequate blood flow), and too much could raise intracranial pressure (ICP)

Hypertension may reduce cerebral perfusion, because of increased cerebrovascular resistance. There will be structural thickening and luminal narrowing of cerebral resistance vessels. These adaptive changes, while protecting the brain against high intravascular pressure, render the brain more susceptible to ischemia at low blood pressure.

Question 7

Which antihypertensive can cause cough (1)

Answer 7

Angiotensin converting enzyme inhibitor (ACEI)

Question 8

Would you perform any dental procedures(if px has hypertension)? Why? What precautions to take? (3)

Answer 8

180/110 mmHg as the absolute cutoff

Limit use of adrenaline - max recommended dose of local anesthetic solution for hypertension (poorly controlled):
two 1.8-ml cartridges (total dose of 3.6 ml) with 1:100,000 (0.036 mg) epinephrine per appointment.

Reduce anxiety of patient

Avoid prescribing NSAID, as it
decreases the antihypertensive effect, since inhibition of renal prostaglandin synthesis decreases renal perfusion, increasing water and sodium retention.

Question 9

What analgesic you would give for extraction + hypertension (2)

Answer 9

NSAID may not be suitable as it can decrease antihypertensive effect of the anti-hypertensive drugs.

Paracetamol 500 – 1000 mg, QID, no strict duration

Question 10

Look at hypertensive drug table pg7-8 old written doc

Answer 10

.