General
An elevated BP that persists on repeated measurements at the 95th percentile or greater for age, height, and gender
Child/adolescent HTN
HTN may remain asymptomatic disease for many years with the only sign being…
An elevated BP
BP goal for most pts with HTN
<140/90mmHg
The physical ability of the pt to perform normal, everyday tasks and activities.
Functional capacity
This type of HTN gradually increases with age and is the most prevalent form of HTN.
Isolated systolic HTN
Common symptoms of HTN
Headache
Tinnitus
Dizziness
BP goal for hypertensive pts with diabetes or kidney disease
<130/80mmHg
Medication that can be given to pts that present with anxiety
When should it be taken?
-Short acting benzodiazepine (triazolam, diazepam, lorazepam) or nitrous + O2
-1hr before the start of dental appt
This type of HTN does not have any identifiable cause and makes up 90% of pts diagnosed with HTN.
Primary (essential) HTN
Earliest sign of HTN
What other examination may show early changes of HTN?
-elevated BP
-funduscopic examination of the retina consisting of narrowed arterioles with sclerosis
Stages of HTN the JNC7 suggests tx
All pts with HTN stages 1 and 2
Common side effect of antihypertensive agents
How can we avoid this in the dental office?
Orthostatic HTN
-avoid rapid changes in chair position, ensure pt has good balance and stability
For every increase in BP of ____mmHg systolic and ___mmHg diastolic, there is a DOUBLING of mortality related to ischemic heart disease and stroke.
20mmHg systolic
10mmHg diastolic
Two peripheral arterial changes that may occur in advanced HTN
Fatigue and coldness in the legs
A severe elevation in BP with evidence of impending or progressive target organ dysfunction.
Recommended tx?
Hypertensive emergency
Immediate BP reduction within 1hr and be admitted to an ICU
At this BP, tx should be terminated.
What is the next step?
>179/109mmHg
-Refer pt to physician and reschedule remainder of appt
The higher the BP, the greater the risk for what 4 significant events?
-Heart failure
-Stroke
-Kidney disease
These 3 events may result from accelerated malignant HTN which is a medical emergency and requires immediate intervention
Retinal vessel hemorrhage, exudate, and papilledema
Determination of risk includes evaluation of which 3 factors
Risk imposed by: pt’s cardiovascular disease, the surgery or procedure, by the pt’s functional reserve/capacity
2 medications that can exacerbate the hypotension effect of calcium channel blockers
Erythromycin, clarithromycin