Hypertension

&
Hypertensive
Heart Disease
Cherrisa Pham
Armando Chavez
Paula Philpott
 Contents
 Definition

 Types of Hypertension

 Etiology

 Levels of Blood Pressure

 Signs/Symptoms

 Indications/Contraindications

 Management

 Treatment
 Hypertension
 Hypertension or high blood pressure is an abnormal elevation
of arterial blood pressure. Also, known as the “Silent Killer”
for its lack of symptoms.

 It is a contributing factor to many vascular diseases or an effect

of underlying pathological changes.

 Early detection and knowledge of the health problems of

patients is needed to ensure treatment is safe and risk of
emergencies.

 Persistent readings of high BP is considered to be at or above

140/90 mm Hg.
 Occurrence
 Hypertensive disease affects 65 million Americans of the
population in the U. S.

 Varies by age, race, education, etc

 The disease affects more African Americans than any other

race. More common in males than in women, and usually
begins at the age of 20 and older.

 Age (over 55 years for men, over 65 years for women)

 The newest at-risk populations for high blood pressure are

children and adolescences.
 Etiology
Two types of hypertension Primary & Secondary.
Primary/Essential Hypertension Secondary Hypertension
* Condition of elevated BP with no * Condition of elevated BP with some
underlying cause. specific underlying cause.

Incidence: Approximately 90% Incidence: Approximately 10%

 Predisposing or Risk Factors:  Risk factors:

Combinations of the risk factors are  Oral contraceptives
more significant.  Renal disease
• Tobacco use  Endocrine disease
• Heredity  Medications
• Overweight
• Salt
• Sex
• Age
• Environment
• Diabetes
• Alcohol
 Signs & Symptoms
Severe Headaches Dizziness

Sweating Loud Heart Sounds

Visual Disturbances Weakness

Tinnitus Tingling in hands and feet

Hypertensive Heart Disease
*Hypertensive Heart Disease is a condition caused by hypertension

*Leading cause of death from high blood pressure

*heart failure
*thickening of the heart muscle
*coronary artery disease
* and other conditions

Emergencies
Patients with hypertension are at risk of cardiovascular disease, therefore,
angina, stroke, arrhythmia, and MI should all be anticipated as possible
occurrence.
 White Coat Hypertension
 a persistently elevated office blood pressure in the presence of a
normal blood pressure outside of the office
 Treatments
 There is no cure for hypertension but goals, medications, and lifestyle changes can be
addressed.
 Goals:
 Primary hypertension: Achieve and maintain diastolic pressure level below 90mm
Hg.
 Secondary hypertension: Medical treatment of underlying systemic disease is
needed.
 Lifestyle changes:
 Weight and exercise

 Diet (low salt, rich potassium & calcium)

 Tobacco Cessation

 Moderate alcohol consumption

 Medications
 Diuretics

 Beta-blockers: propranolol, carvedilol, metoprolol

 ACE inhibitors

 Calcium channel blockers

 Angiotensin receptor blockers (ARBS)

 Aldosterone-receptor blocker: spironolactone, eplerenone

Adverse Effects of Antihypertensive Drugs

 Thiazide (Diuretics)  Xerostomia

 Nifedipine (Calcium Channel Blocker)  Gingival Hyperplasia

 Propranolol (Antihypertensive)  Oral Lichenoid Reaction

 Acetazolamide (ACE inhibitors)  Dysgeusia/Ageusia

(cough & taste alteration)
 Indications and Contraindications for
dental treatment
 Special attention because any stressful procedure may increase BP and trigger acute
complications.

 Xerostomia

 Bleeding

 Vasoconstrictor usage: (Benefit must outweigh the risk)

 For uncontrolled Hypertension: Avoid ALL Dental Procedures
 Controlled Hypertension: limit the amount of vasoconstrictor usage
 Best Choice: Plain local anesthetic, 1:200,000 epinephrine concentrations; 2%
mepeivacaine hcl

 Long-term use of NSAIDs

 Periodontal Management
 Update Medical/Dental History

 Assess Vitals at every recall appointment

 Obtain ACCURATE/ROUTINE BP Measurements

 Monitor plaque/bleeding score due to several oral

complications

*** Patients who have oral complications from prolonged usage of

medications may suffer from severe periodontitis.
 Accepted & Expected
Treatment Options
 Recall 3-6 months (varies)

 Short Morning Appointments

 Stress-Reduction Protocols

 Supine chair positioning  have patient sit upright for at least 2 min.
before standing to avoid orthostatic hypotension.

 Advise patient to take medication as they normally would.

 There is NO pre-medication for dental treatment.

 Oral premedication can be considered to reduce anxiety
 Ex: Triazolam
 Teach Patient/Family
 Encourage effective Oral Hygiene

 Use caution with oral aids to prevent injury

 Homecare instructions for xerostomia

 Alcohol mouth rinses
 Chew sugarless gum
 Frequent sips of water
 Saliva substitutes
 Use daily home fluoride
1. What is considered stage 1 hypertension?

a. 160>108
b. 123>99
c. 133>88
d. 100>72
e. None of the above
2. Which medication is not used to treat hypertension?

a. Metoprolol
b. Lisinopril
c. Propranolol
d. Cyclosporine
e. all of the above
3. What is the best patient chair positioning?

a. Supine
b. Semi-Supine
c. Upright
d. Trendelenburg
e. A and B
4. Which are not adverse effects of antihypertensive drugs?

a. Oral Lichenoid Reaction

b. Gingival Hyperplasia
c. Exophthalmos
d. Xerostomia
e. Dysgeusia
5. What will raise your blood pressure?

a. State Board
b. White Coat Hypertension
c. Mrs. Harrell’s Raised Eyebrows
d. Pink Sheets
e. All of the above
 References
 Gehrig-Nield, J.S., & Willmann, D. E. (2013). Patient Assessment
Turtorials. (3rd ed.) Baltimore, MD: Wolters Kluwer.

 Wilkins, E. M. (2017). Clinical Practice of the Dental Hygienist. (12th ed.)

Baltimore, MD: Wolters Kluwer

 Sanda Mihaela Popescu, Monica Scrieciu, Veronica Mercuţ, Mihaela

Ţuculina, and Ionela Dascălu, “Hypertensive Patients and Their
Management in Dentistry,” ISRN Hypertension, vol. 2013, Article ID
410740, 8 pages, 2013. doi:10.5402/2013/410740

 Medlineplus.gov