1. High Blood Pressure and Cardiovascular Disease

What is blood pressure?

lateral pressure put on blood vessel walls

#1 Cause of Cardiovascular disease

hypertension

normal BP

BELOW 120/80 mm Hg

elevated BP

>120/>80 mmHg

replaces “pre-hypertension” -NOT A THING ANYMORE

cause of Primary or Essential Hypertension

unknown cause >95%

Secondary Hypertension

Result of other diseases

ex:

Pheochromocytoma

Renovascular disease (Renal artery stenosis) - thinning of blood vessel

Hyperaldosteronism – Conn Syndrome (Adenoma)

Coarctation of the aorta

Pheochromocytoma

tumor of adrenal medulla (secretes adrenaline)

adrenal cortex secretes

glucocortocoids

mineralcortocoids

sex hormones

adenoma

tumor of adrenal cortex

high aldosterone → retain Na → retain H2O

Coarctation of the aorta

endothelium of aorta gets damaged → inc BP

menopause increases risk of heart disease because

of the decrease of estrogen

estrogen is cardioprotective

BP chart *KNOW THESE

Normal BP

Less than 120/80 mm Hg

Elevated BP

Systolic between 120-129 and diastolic less than 80

Stage 1 hypertension

Systolic between 130-139 or diastolic between 80-89

Stage 2 hypertension

Systolic at least 140 or diastolic 90 mm Hg or higher

Hypertensive crisis

Systolic over 180 and/or diastolic over 120

is systolic or diastolic more important in normal people

diastolic should be lower than systolic in healthy individuals

2025 Latest Updated Guidelines for High Blood Pressure

Pre-hypertension does not exist as a category.

High BP should be treated earlier with lifestyle changes

Patients should be pharmacologically treated at 130/80 mm Hg rather than 140/90 – based on new ACC and American Heart Association (AHA) guideline

another name for stroke

cerebral vascular accident CVA

managing hypertension

Conservative management/ Lifestyle change

Including active intervention for smoking and drinking alcohol.

Prescribing for Stage I hypertension if a patient has had a cardiovascular event (MI or CVA) when at high risk of MI CVA

Presence of diabetes mellitus, chronic kidney disease or atherosclerotic risk (high cholesterol)

Patients may need two or more types of medications

Compliance: multiple medications in a single pill

Identifying socioeconomic status and psychosocial stress as risk factors for high blood pressure

LDL

deposits cholesterol in blood vessels → plaque → atherosclerosis

essential hypertension environmental factors

secondary hypertension environmental factors

primigravida

first pregnancy

eclampsia

seizures during pregnancy

how does birth control → increase in BP

increasing estrogen and progesterone →increase in aldosterone → increase in sodium

NSAIDS for more than 5 days can cause

antihypertensives to stop working bc they work in the kidneys and NSAIDS are broken down in the kidneys

mechanisms of hypertension: RAAS

renin-angiotensin-aldosterone

angiotensin II → vasocontrict

aldosterone → retain sodium

angiotensinogen is secreted by the

liver

renin comes from

kidneys

what activates angiotensinogen

angiotensin I

angiotensin I

comes from blood vessels

does NOTHING

converted to angiotensin II by ACE

ACE

secreted by bronchi, endothelium, top of trachea

dry hacking cough is caused by what drugs

ACE inhibitors

Target Organ Damage

Heart

Left ventricular hypertrophy

Angina or myocardial infarction

Prior coronary revascularization CABG (coronary artery bypass graft, homograph- comes from self)

Heart failure

Brain: Stroke or transient ischemic attacks

Chronic kidney disease

Peripheral arterial disease

Retinopathy

Hypertensive crisis

Acute elevation of BP associated with end organ damage

Potentially fatal!

Hypertensive Crisis/ Hypertensive emergency/ Malignant Hypertension

BP= 180/120 mmHg x 2 consecutive readings

Possible from post-surgical hypertension

Patients who develop a hypertensive crisis: Stop dental procedure!

Damage to nervous tissue, renal end arteries and retinal arteries as well as ischemia to the mural cardiac musculature

Medical emergency in dental clinic

All the following tumors may cause substantially increased BP EXCEPT:

a. Pheochromocytoma

b. Parotid tumor

c. Wilm's tumor

d.Thyroid tumor

b. Parotid tumor

Common causes of hypertension

Antihypertensive drug withdrawal (clonidine - alpha 2 agonist, centrally active)

Autonomic hyperactivity (sympathetic)

Collagen vascular disease (Systemic lupus erythematosus SLE)

Renal disease (stenosis)

Trauma to the head (contusion, lose conciousness for a long time)

Neoplasia (pheochromocytoma)

Pre-eclampsia (Leading onto eclampsia)

Recreational drugs (cocaine, MDMA, tobacco, adderall (dextroamphetamine), pseudoephedrine)

Major Cardiovascular Risk Factors

Hypertension

Cigarette smoking

Obesity (body mass index ≥30 kg/m2)

Abdominal girth: > 40 inches (men) and > 35 inches (Non- pregnant women)

Physical inactivity

Hyperlipidemias

Diabetes mellitus

Microalbuminuria or estimated GFR <60 mL/min (kidneys)

Age (older than 55 for men, 65 for women)

Family history of premature cardiovascular disease

Identifiable causes of hypertension

Sleep apnea

Drug-induced or related causes

Chronic kidney disease

Primary aldosteronism

Renovascular disease

Chronic steroid therapy and Cushing’s syndrome

Pheochromocytoma

Coarctation of the aorta

Thyroid or parathyroid disease

BP equation

Blood Pressure = Cardiac Output x Peripheral Vascular Resistance KNOW

Antihypertensive Drugs

Diuretics

Angiotensin Converting Enzyme (ACE) inhibitors ("-pril”)

Angiotensin Receptor Blockers (“-sartan”)

Calcium channel blockers (“-dipine”)

Beta blockers (“-olol”)

Alpha blockers (phentolamine)

Centrally acting Antihypertensives (clonidine)

Vasodilators (nitro or glycerine)

Diuretics

Diuretics act at various sites in the nephron to increase urine production.

Inhibit sodium reabsorption from the nephron into circulation causing an increase in excretion of sodium in urine