

Hypertension (HTN or HT), also known as

high blood pressure (HBP), is a long-term
medical condition in which the blood pressure
in the arteries is persistently elevated. High
blood pressure typically does not cause
symptoms
* instrument used to measure
hypertension:


Sphygmomanometer-
- -mercury manometer-
also known as a blood pressure meter,
blood pressure monitor, or blood pressure
gauge.
 
Hypertension is classified as either primary 
(essential) high blood pressure or secondary high blood
pressure.
About 90–95% of cases are primary, defined as high 
blood pressure due to nonspecific lifestyle and genetic
factors. Lifestyle factors that increase the risk include
excess salt in the diet, excess body weight, smoking, and
alcohol use.
The remaining 5–10% of cases are categorized as 
secondary high blood pressure, defined as high blood
pressure due to an identifiable cause, such as chronic
kidney disease, narrowing of the kidney arteries,
an endocrine disorder, or the use of birth control pills.

Environmental factor:

1) high salt intake . 
2) heavy consumption of alcohol . 
3) obesity . 
4) lack of exercise . 
5) impaired intrauterine growth . 
6) stress . 
Symptoms

-A person with hypertension may not notice any 
symptoms, and so people often call it the "silent
killer." Without detection, hypertension can damage
the heart, blood vessels, and other organs, such as
the kidneys.
-It is vital to check blood pressure regularly. 
-In rare and severe cases, high blood pressure causes 
sweating, anxiety, sleeping problems, and blushing. -
-However, most people with hypertension will
experience no symptoms at all.
-If high blood pressure becomes a hypertensive 
crisis, a person may experience headaches and
nosebleeds.


Complications:

-Heart attack or stroke : High blood pressure can cause 
hardening and thickening of the arteries (atherosclerosis),
which can lead to a heart attack, stroke or other complications.
-Aneurysm : Increased blood pressure can cause your blood 
vessels to weaken and bulge, forming an aneurysm. If an
aneurysm ruptures, it can be life-threatening.
-Heart failure : To pump blood against the higher pressure in 
your vessels, the heart has to work harder. This causes the walls
of the heart's pumping chamber to thicken (left ventricular
hypertrophy). Eventually, the thickened muscle may have a
hard time pumping enough blood to meet your body's needs,
which can lead to heart failure.
-Weakened and narrowed blood vessels in your kidneys : This 
can prevent these organs from functioning normally.
 
-Thickened, narrowed or torn blood vessels in the eyes: •
This can result in vision loss.
-Metabolic syndrome :This syndrome is a cluster of disorders •
of your body's metabolism, including increased waist
circumference; high triglycerides; low high-density lipoprotein
(HDL) cholesterol, the "good" cholesterol; high blood pressure
and high insulin levels. These conditions make you more likely
to develop diabetes, heart disease and stroke.
-Trouble with memory or understanding : Uncontrolled high •
blood pressure may also affect your ability to think, remember
and learn. Trouble with memory or understanding concepts is
more common in people with high blood pressure.
-Dementia : Narrowed or blocked arteries can limit blood flow •
to the brain, leading to a certain type of dementia (vascular
dementia). A stroke that interrupts blood flow to the brain also
can cause vascular dementia.

White coat hypertension :

more commonly known as white coat 
syndrome, is a phenomenon in which people
exhibit a blood pressure level above the
normal range, in a clinical setting, although
they do not exhibit it in other settings. It is
believed that the phenomenon is due to
anxiety experienced during a clinic visit.
Hypertensive crises :


*Hypertensive emergencies 
high BP associated with target organ damage . 
*requires treatment in ICU with constant monitoring of 
BP hypertensive urgencies
high BP but on organ damage . 
*Treatment :
-sodium nitroprusside .
-nifedipine .
-nitroglycerine.
-hydralazine.
-labetolol .
Management:

**Lifestyle modifications: 
The first line of treatment for hypertension is identical to
the recommended preventive lifestyle changes[13] and
includes dietary changes,[14] physical exercise, and weight
loss. These have all been shown to significantly reduce
blood pressure in people with hypertension.[15] Their
potential effectiveness is similar to and at times exceeds a
single medication.[11] If hypertension is high enough to
justify immediate use of medications, lifestyle changes are
still recommended in conjunction with medication.
 
**Medications : most common drugs ..
-Thiazide diuretics : (chlorothiazide, polythiazide,
indapamide, metolazone)
-Angiotensin-converting enzyme inhibitors : (benazepril,
captopril, lisinopril, ramipril)
-Angiotensin receptor blockers :
(candesartan, eprosartan, valsartan)
-Beta blockers :
(propranolol, timolol, nadolol, metoprolol)
-Calcium channel blockers :
(amlodipine, felodipine, diltiazem, verampil)
Hypertension in dentistry..

Dental treatment can be provided for all
patient with hypertension except
uncontrolled hypertension.

Patients with blood pressure less than 180/110
can receive any dental treatment, put patient
blood pressure should be monitored during
treatment if blood pressure 160/100.
 Guidelines for blood pressure.

Blood pressure ASA classification Dental therapy
(in mm Hg) consideration
<140 & <90 I 1) Routine dental
management.
2) Recheck in 6 months.
140-159 & 90-94 II 1) Recheck BP prior to
dental treatment for three
consecutive appointments;
if all exceed these
guidelines, medical
consultation is indicated.
2) Routine dental
management .
3) Stress reduction protocol
as indicated.
Blood pressure ASA classification Dental therapy
(in mm Hg) consideration

160-199 &/or 95-114 III 1) Recheck blood pressure

in 5 minutes.
 2) If still elevated, medical
consultation before dental
therapy.
3) Routine dental therapy.
4) Stress reduction protocol.

>200 &/or >115 IV 1) Recheck blood pressure

in 5 minutes.
2) Immediate medical
consultation if still
elevation.
3) No dental therapy,
routine or emergency , until
elevated BP corrected.
4) Refer to hospital if
immediate dental therapy
indicated.
Pre operative medication and
management:

-Patient BP should be monitored & controlled within
normal.
-To antihypertensive patient morning dose of •
medication prior to surgery must be given.
Intra and post operative
management :

-Blood pressure should be monitored continuously . (1
-Patient cardiac status also monitored . (2
-Antihypertensive must be continued . (3
-If the procedure is performed under local (4
anesthesia, the local anesthetic without adrenaline is
to be used.
 some consideration for hypertensive
patient include:

*chair position: avoid rapid position change .
* Avoid use of retraction cords.
* Avoid use topical hemostatic agent containing
epinephrine instead use tatrahydrozoline
oxymetazoline .
 
*Antibiotics: patient taking calcium channel blockers 
should not given erythromycin/clarithromycin
(azithromycin is OK) .
*Analgesics: avoid long-term use of NSAIDs (more 
than 2 weeks) because it interfere with action of the
drug.
*anesthesia: it is not recommended to use more than
2 anesthetic carpules (with 1:100,000 epinephrine).
More
carpules may cause elevation of blood pressure .
*Anxiety: anti-anxiety drugs can be used , however,
dose should be minimized for such patients
(hypotension).
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 
Ahmad abu alrob 
Fares faqeh 