Hypertension Overview and Complications

Study Notes

Hypertension is persistently elevated blood pressure, specifically systolic blood pressure above 140 mmHg or diastolic blood pressure above 90 mmHg.
The 2020 American Heart Association guidelines classify hypertension based on office blood pressure measurements.
High-normal blood pressure (BP) individuals might benefit from lifestyle interventions. Pharmacological treatment may be necessary if compelling indications exist.
Grade 1 and Grade 2 hypertension individuals should receive pharmacological treatment.

Hypertension can remain asymptomatic for years.
Early symptoms may include headache, blurred vision, tinnitus, dizziness, and fatigue.

Blood pressure exceeding 180/120 mmHg + evidence of organ dysfunction
Possible symptoms such as intracerebral hemorrhage, unstable angina pectoris, acute myocardial infarction, or heart failure.
Clinical picture may include chest pain, dyspnea, changes in mental status, visual disturbance, or neurologic deficit.

Lifestyle changes such as weight loss, a low-salt diet, smoking cessation, and alcohol avoidance.
Antihypertensive medications including diuretics, beta blockers, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, and vasodilators.

Facial palsy
Side effects of antihypertensives, such as xerostomia (dry mouth) and salivary gland swelling
Other potential oral complications like lichenoid reaction, erythema multiforme, angioedema.

During the initial dental visit, dentists should identify undiagnosed hypertensive patients through detailed history and routine blood pressure measurement.
Delay or refer dental treatment in cases of undiagnosed patients, uncontrolled blood pressure above baseline values (systolic above 180 mmHg or diastolic above 100 mmHg).
Pharmacological management of emergency dental conditions until the patient is controlled.
Stress-reduction protocol to avoid endogenous adrenaline release and greater blood pressure rise.
Avoid sudden changes in chair position to prevent drug-induced orthostatic hypotension.
Bleeding is not usually caused by hypertension but by anticoagulants used by hypertensive patients.
Epinephrine-containing local anesthetics can be used carefully to delay systemic absorption and increase the duration of anesthesia.

Prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs) can reduce the efficacy of antihypertensive medications.
Erythromycin and clarithromycin increase the hypotensive action of calcium channel blockers.

Persistent reduction in blood supply and oxygen supply to the heart through the coronary arteries, caused by thrombus obstruction or arterial wall thickening (atherosclerosis).
Depending on the duration and extent of ischemia, the heart may experience angina pectoris or myocardial infarction (MI).
Angina pectoris: Temporary low oxygen supply to a part of the heart muscle, often causing chest pain.
Myocardial infarction (MI): Necrosis of a part of the heart muscle due to permanent loss of blood and oxygen supply.

Stable angina, unstable angina, and myocardial infarction can all manifest as chest pain with varying characteristics and causes.

A patient experiencing chest pain during dental treatment must halt procedures, place the patient upright, ensure an open airway and adequate breathing and circulation, administer nitroglycerin sublingually, provide oxygen, and constantly monitor vital signs.
Immediate emergency interventions like calling for an ambulance, oxygen administration, aspirin usage, and initiating basic life support (CPR), or using an AED should be considered if there are signs of cardiac arrest.
Pain relief within five minutes is expected. Pain persisting longer, related to nausea, vomiting, syncope, or hypertension, strongly suggests a myocardial infarction (MI) requiring immediate medical attention.