Hypertension/Hypertensive Heart Disease

Cecily Fontenot
Marley McHenry
Christen Kennon
What is hypertension?

Abnormally high _______________

Being at a state of great psychological stress
When the volume of ________________ mechanisms fail and the blood volume
becomes greater than the limited volume capacity of the vascular compartment

AKA __________________
2 types of hypertension
Primary hypertension
Related to _________________ and environmental factors
Heritable component is unclear
Environmental: dietary sodium, obesity, and stress
Secondary hypertension

___________ of the population have secondary hypertension

Has an identifiable and correctable cause
Excessive ______________ of sodium, licorice, and alcohol
Certain medications

White coat hypertension vs. masked hypertension

White coat hypertension

When _______________ is higher than blood pressure measured out of office

Stress/anxiety
Patient should be instructed to take their blood pressure routinely at home
Masked hypertension

When Blood pressure is _________________ when measured in the office and higher
outside the office
Patient should monitor their blood pressure for 24 hours

Medications linked to hypertension

Oral contraceptives: estrogens

Illicit drugs: _______________ and cocaine
NSAIDS
Steroids
________________________: decongestants and diet pills
CNS drugs: buspirone, carbamazepine, clozapine, fluoxetine, lithium, tricyclic
antidepressants
Herbals:_______________ and Ginseng

Occurrence of Hypertension

30% of Americans have prehypertension

Only __________ of those diagnosed with hypertension are receiving therapy.
Hypertension is not known to affect any certain race but can affect those of all ages.

Organ Damage due to hypertension

Heart
Left ventricle ____________
Angina/ prior MI
Prior coronary _____________________
Heart failure
Brain
Stroke
Transient ________________ attack
Dementia
Chronic kidney disease
Peripheral arterial disease
Retinopathy

Lifestyle and Cardiovascular risk factors

__________________________
Age: men >55 years, women >65 years
Diabetes mellitus
High LDL or low LDL ____________________

Family history of cardiovascular disease

Microalbuminuria
Obesity
Tobacco usage

Signs and Symptoms

Restlessness
Flushed face
Headache, dizziness, tinnitus
Visual disturbances
___________________
A hammering pulse
Altered mental state
Chest pain
Seizure

Treatment of Condition

Lifestyle Modifications
Weight reduction
______________________________
Dietary sodium reduction
Physical activity
Moderation of alcohol consumption
Medications
Lisinopril
Amlodipine
Benicar
Losartan
Metoprolol
____________________
Avapro
Diovan

Indications for dental treatment

Provide local anesthesia of excellent quality

Make slow changes to chair position to avoid ______________________ hypotension

Record pre- and post- operative vitals
Make sure patients vitals are stable prior to __________________
Review health status including all medications being taken
Minimize stress/consider oral sedative premedication
Refer to physician if BP is ____________________

Contraindications for dental treatment

Patients on nonselective beta blockers, limit _______________________ to no more

than two cartilages of 1:100,000 epinephrine
Avoid epinephrine containing retraction cord
Patients with upper level stage 2 hypertension consider
______________________________
If blood pressure reaches 180/110, you should terminate appointment
Use caution when prescribing post operative antibiotics as some can interact with
hypertensive medications

Emergency situations

Return patient to _____________ position

Administer oxygen (6L/min)
Monitor blood pressure and pulse rate
When BP returns to baseline values, allow patient to assume a sitting position for 2
minutes
Allow patient to _________________ for 2 minutes
Medical referral for evaluation and appropriate risk modifications

How will oral health be impacted?

Hypertension will not affect oral health alone; however medications can cause some side
effects.

Oral health and medications

Calcium channel blockers- ___________________ overgrowth

ACEIs- neutropenia, delayed healing, gingival bleeding, oral burning, angioedema, and
persistent cough
Diuretics- ____________
Thiazides, methyldopa, propranolol, and labetalol- lichenoid reactions
_______________ diuretics- oral lesions associated with and allergic or toxic base

Hypertension and periodontitis

There is no proven study showing hypertension linked to periodontitis

There are risk factors causing hypertension that can lead to periodontitis as well such as:
Smoking
______________
Inflammation
Diet
Medications
Genetic factors

Dental Hygiene care for the hypertensive patient

Most patients will not need antibiotic premed, but may possibly need an anti-anxiety
premed to reduce stress during the procedure
Certain medications may require the patient to be seated _____________________
Short appointments should be considered to help reduce stress
Your area should be clutter free and organized
Keep needles/sharp instruments out of direct sight
__________________ use is not indicated or contraindicated
Patients should be on a 6 month recall unless their periodontal status is moderate. Then
they should be 3 months.

Questions!!

1.) Which of these is a risk factor to the hypertensive patient?

A. Medication
B. Smoking
C. Obesity
D. All of the above

2.) Primary hypertension has an identifiable and correctable cause. Secondary hypertension
is among 5-10% of the population.
A. Both statements are true
B. The first statement is true and the second statement is false
C. Both statements are false
D. The first statement if false and the second statement is true

3.) What is NOT caused by organ damage to the heart?

A. Heart failure
B. Prior coronary revascularization
C. Stroke
D. All of the above