Hypertension Dental Considerations PDF

HYPERTENSION Sean Moncrieffe, Pharm.D., MBA, MPH, BPharm, Dip.Ed., RPh.  The relationship between BP and risk of CVD events is continuous, consistent, and independent of other risk factors. The higher the BP, the greater is the chance of heart attack, heart failure, stroke,...

HYPERTENSION Sean Moncrieffe, Pharm.D., MBA, MPH, BPharm, Dip.Ed., RPh.  The relationship between BP and risk of CVD events is continuous, consistent, and independent of other risk factors. The higher the BP, the greater is the chance of heart attack, heart failure, stroke, and kidney disease.  The risk of developing CVD doubles for every increment of 20 mm Hg SBP or 10 mm Hg of DBP I. Taking Blood Pressure  HTN detection begins with proper blood pressure measurements  Repeated BP measurements will determine whether initial elevations persist and require prompt attention or have returned to normal and need only periodic surveillance.  Blood pressure should be measured in a standardized fashion using equipment that meets certification criteria. The following techniques are recommended:  Patient seated in a chair with back supported  arms bared and supported at heart level  Patients should refrain from smoking or ingesting caffeine during the 30 minutes preceding the measurement.  Measurement should begin after at least 5 minutes of rest.  The appropriate cuff size  The bladder within the cuff should encircle at least 80 percent of the arm.  Measurements should be taken preferably with a mercury sphygmomanometer  All measurements, including both SBP and DBP, should be recorded.  The first two or more readings separated by 2 minutes should be averaged when determining risk.  If the first two readings differ by more than 5 mm Hg, additional readings should be obtained and averaged. Evaluation of patients with documented hypertension has three objectives: 1. to assess lifestyle and identify other cardiovascular risk factors or concomitant disorders that may affect prognosis and guide treatment 2. to reveal identifiable causes of high BP 3. to assess the presence or absence of target organ damage and CVD.  1. Medical history,  2. Physical examination,  3. Routine laboratory tests,  4. Other diagnostic procedures. Goals of Therapy  Reduction of cardiovascular and renal morbidity and mortality.  Treating SBP and DBP to targets that are 110 1. Retake and confirm blood pressure with alternate device 2. If blood pressure is unchanged, consider immediate referral of the patient to a physician or emergency room for evaluation. 3. No treatment of any type 4. Medical consult required prior to any dental treatment.  Common Antihypertensive Dental Side Effects DRUG CLASS DENTAL SIDE EFFECTS Beta-blockers Dry mouth, taste changes, lichenoid reaction ACE inhibitors Dry cough, loss of taste, dry mouth, ulceration, angioedema Angiotensin II receptor blockers Dry mouth, angioedema, sinusitis, taste loss Calcium channel blockers Gingival enlargement, dry mouth, altered taste Alpha-blockers Dry mouth Alpha-2 agonists, central-acting Dry mouth, taste changes, parotid pain Diuretics Dry mouth, lichenoid reaction, orthostatic hypotension Vasodilators Facial flushing, possible increased risk of gingival bleeding, and infection Renin inhibitors Angioedema, rash, cough, tinnitus, parosmia Peripheral dopamine-1 receptor agonist Leukocytosis, bleeding