Académique Documents
Professionnel Documents
Culture Documents
2
Blood Pressure
• The pressure
exerted by the
blood against
the interior
walls of the
arterial system
• Sounds produced
by turbulent
blood flow are
called Korotkoff
sounds, after
the Russian
physician who 3
Korotkoff sounds: First
appearance of sounds is the
systolic pressure; the complete
disappearance of sounds is the
diastolic pressure.
4
Blood Pressure and
Cardiovascular Risk
6
Causes of Hypertension
• 95%: cause undetermined (essential
hypertension)
•
• 5%: identifiable and potentially correctable
causes of hypertension
– Chronic kidney disease
– Coarctation of the aorta
– Cushing syndrome; chronic steroid
therapy
– Drug induced or drug related
– Obstructive uropathy
– Pheochromocytoma
– Primary aldosteronism
– Renovascular disease
– Thyroid or parathyroid disease
– Sleep apnea
7
Hypertension is an insidious disease
and may remain completely
asymptomatic for many years
Measurement of blood pressure is the
only means of detection
8
Target Organ Damage
(occurs after many years of elevated blood
pressure)
• Heart
– Left
ventricular
hypertrophy
– Angina/prior
MI
– Prior coronary
revasculariza
tion
– Heart failure
• Brain
– Stroke or TIA
– Dementia
• Chronic kidney
disease
• Peripheral arterial
disease
• Retinopathy
9
Classification of High Blood
Pressure: JNC 7
BP Classification Systolic BP Diastolic
BP
Normal <120 <80
Prehypertension 120-139 80-89
Stage 1 140-159 90-99
Stage 2 >160 >100
• Pharmacologic Management
11
Lifestyle Modifications
Weight loss if overweight
Adopt DASH (dietary approaches to stop
Stop smoking
12
Oral Antihypertensive
Drugs
Decision to prescribe
depends upon:
Degree of BP elevation
Presence of target organ
damage
Presence of cardiovascular
disease
Risk factors 13
Diuretics
• Thiazides (Diuril,
hydrochlorthiazide, HCTZ)
• Loop Diuretics (Lasix)
• K-Sparing Diuretics
(Midamor, Dyrenium)
• Combination (Aldactazide,
Dyazide)
14
Beta Blockers
Cardioselective (β-1) Non-Selective (β-
acebutol (Sectral) 1&2)
atenolol (Tenormin) cartelol (Cartrol)
betaxolol (Kerlone) labetalol
bisoprolol (Zebeta) (Trandate)
metoprolol nadolol (Corgard)
(Lopressor) penbutolol
metoprolol (Levatol)
extended release pindolol (Visken)
(Toprol XL)
propanolol
(Inderal)
propanolol long-
acting
(Inderal LA)
sotalol (Betapace)
timolol
(Blocadren) 15
Combined Alpha-Beta
Blockers
Carvedilol (Coreg)
Labetalol (Normodyne;
Trandate)
16
ACE (angiotensin converting
enzyme) Inhibitors
• Benazepril • Moexipril
(Lotensin) (Univasc)
• Captopril (Capoten) • Perindopril
• Enalapril (Vasotec) (Aceon)
• Fosinopril • Quinipril
(Monopril) (Accupril)
• Lisinopril (Zestril; • Ramipril (Altace)
Prinivil) • Trandolapril
(Mavik)
17
Angiotensin Receptor Blockers
(ARBs)
Candesartan (Atacand)
Eprosartan (Teveten)
Irbesartan (Avapro)
Losartan (Cozaar)
Olmesartan (Benicar)
Telmisartan (Micardis)
Valsartan (Diovan)
18
Calcium Channel
Blockers
Amlodipine (Norvasc)
Bepridil (Bepadin;
Vascor)
Diltiazem (Cardizem)
Felodipine (Plendil)
Isradipine (DyanCirc)
Nicardipine (Cardene)
Nifedipine (Procardia)
Nimodipine (Nimotop)
Verapamil (Calan;
Isoptin)
19
Alpha-1 Blockers
Doxazosin (Cardura)
Prazosin (Minipress)
Terazosin (Hytrin)
20
Central Alpha-2 Agonists and
Other Centrally Acting Drugs
• Clonidine (Catapres)
• Clonidine patch (Catapres-TTS)
• Methyldopa (Aldomet)
• Reserpine (generic)
• Guanfacine (Tenex)
21
Direct Vasodilators
• Hydralazine (Apresoline)
• Minoxidil (Loniten)
22
Decisions
• Elective dental treatment is permissible for patients with BP <180/110 (low risk)
• Encourage patient to see MD for evaluation if BP > 140/90 in untreated patient; explain
the linear relationship of BP and CVD
•
• Encourage patient to see MD for evaluation if BP is not being
•
• Defer elective dental treatment if BP is >180/110 and urge immediate referral
•
• If urgent dental treatment is necessary:
23
Stress Reduction Protocol
• Good patient rapport
• Minimize waiting time
• Short, morning appointments
• Ensure physical comfort
• If anxious or fearful:
– Oral sedation ( night before and/or 1 hour
before appt) with pre, intra, & post-op vital
signs and use of pulse oximeter
– N2O/O2 sedation intra-operatively
• “Painless” injection technique (use topical,
slow administration, ensure adequate
anesthesia)
• Post-op pain control
• Evening phone call
24
Options for Oral
Sedation/Anxiolysis
• Triazolam (Halcion)
0.125-0.25 mg
• Oxazepam (Serax)
10-30 mg
• Lorazepam (Ativan)
2-3 mg
• Alprazolam (Xanax)
0.25-0.5 mg
• Diazepam (Valium)
2-10 mg
•
• Hydroxyzine (Vistaril)
50-100 mg
•
• Zolpidem (Ambien)
5-10 mg hs
• Zaleplon (Sonata)
5-10 mg hs
•
•
•
25
Use of Epinephrine in Local
Anesthetics in Hypertensives
28
Other side-effects or
interactions of
antihypertensive drugs
• Orthostatic hypotension
• NSAIDs (long term use) may
interfere with
antihypertensive effects due
to interference with cyclo-
oxygenase (COX) mediated
prostaglandin formation
• Short-term use of a few days
is not clinically significant
29
Oral Manifestations of
Antihypertensives
30