Oral Medicine Lecture 11: Hypertension & Dental Care

What blood pressure is considered normal?

120/80

What blood pressure is considered elevated?

120 - 129 / < 80

What blood pressure is considered stage 1 hypertension?

130 - 139 / 80 - 89

What blood pressure is considered stage 2 hypertension?

140+ / 90

Does calcium channel blockers cause an increase in extracellular tissue volume or an increase in cell number?

Increase in extracellular tissue volume

What is the main calcium channel blocker that causes gingival hyperplasia?

Nifedipine

How long does it take for gingival hyperplasia to occur after a daily dose of 30 - 120 mg of Nifedipine?

1 - 9 months

How long does it take for the calcium channel blocker Veramamil to cause problems after a daily dose of 240 - 480 mg?

11+ months

Is the severity of hyperplasia dose dependent?

No

When is gingivectomy curative for gingival hyperplasia from calcium channel blockers?

Patient is off calcium channel blockers

What medication could regress hyperplasia from Nifedipine?

Isradipine

What are the four main factors that is associated with increased blood pressure?

1. Overweight

2. Increased salt intake

3. Alcohol

4. Physical inactivity

How much alcohol per day is associated with increased blood pressure?

2 drinks

What sleeping condition is associated with hypertension?

Sleep apnea

What oral feature should you look at to diagnose sleep apnea?

Uvula

What heart issue could impact blood pressure readings?

Aortic regurgitation

What is the sign for aortic regurgitations?

Heart murmurs

What three issues are associated with higher aldosterone levels?

1. Heart Disease

2. Stroke

3. Kidney Disease

What is the target blood pressure for hypertension treatment?

< 130/80

What mental condition is prevented by treating hypertension?

Dementia

What substance do hypertension patients have trouble handling?

Sodium

What bodily system is overstimulated during hypertension?

Sympathetic/Adrenergic nervous system

What causes vasoconstriction during hypertension?

Handling defect of intracellular calcium in vascular smooth muscle?

How long should patients relax on a chair before taking their blood pressure?

5 mins

What is the important proper equipment technique for accurate blood pressure measurements?

Proper cuff size

Which arm should you use for taking blood pressure at the first visit?

Both

Which arm should you use for taking blood pressure at future visits?

Arm with higher blood pressure

What two conditions is isolated systolic hypertension a risk factor for?

1. Congenital heart defect

2. Stroke

What does the sudden onset of hypertension suggest?

Secondary hypertension

Is the compliance of large arteries increased or decreased with systolic hypertension?

Decreased

Is baroreceptor sensitivity increased or decreased with systolic hypertension?

Decreased

Is sympathetic nervous system stimuli increased or decreased with systolic hypertension?

Increased

Are beta receptors increased or decreased with systolic hypertension?

Decreased

Are renin-angiotensin-aldosterone relationships increased or decreased with systolic hypertension?

Decreased

Is creatinine clearance increased or decreased with systolic hypertension?

Decreased

Is there volume expansion or reduction with systolic hypertension?

Expansion

Which four organs are mostly affected by hypertension?

1. Eyes

2. Heart

3. Kidney

4. Vasculature

What is the cerebral acute event that could happen with hypertension?

Cerebrovaacular accident

What is the heart acute event that could happen with hypertension?

Myocardial infarction

What diet is used to prevent hypertension?

DASH diet

What supplement is used to prevent hypertension?

Postassium

What intake should be reduced to prevent hypertension?

Sodium

What is the most concerning side effect for ACE inhibitors?

Angioedema

What is the central-acting agonist that could be safely used in pregnancy?

Methyldopa

What is the main concern for methyldopa?

Dry mouth

What are the two main side effects of calcium channel blockers?

1. Dizziness

2. GERD

What are the two contraindications for calcium channel blockers?

1. Acute myocardial infarction

2. Unstable angina

What is the main issue of beta blockers with hypertension?

Could raise blood pressure

What lesions are caused by beta-blockers?

Lichenoid lesions

Which mucosal inflammatory cutaneousand mucous membrane reaction is caused by antihypertensives?

Lichen planus

What percent of lichen planus undergo malignant transformation?

1.2%

At what blood pressure is epinephrine contraindicated?

200+ / 115+