Hypertension Pharmcology

Definition Diastolic blood pressure  90 mm Hg Blood pressure (BP) is the pressure of circulating blood on the walls of blood vessels. Hypertension basically means high blood pressure Systolic blood pressure  140 mm Hg Diastolic blood pressure  90 mm Hg

Types of Hypertension 1. Primary (Essential) -Which develops gradually over many years & has no underlying cause. -Most common form of hypertension -90% to 95% of people have this type of hypertension. 2. Secondary -Elevation of blood pressure associated with another disease such as kidney disease endocrinal disturbances, neurologic causes etc. -5% to 10% in adults

Factors Influencing BP ■ Sex … M > F …due to hormones/ equal at menopause. ■ Age … Elderly > children …due to atherosclerosis. ■ Emotions  due to secretion of adrenaline & noradrenaline. ■ Exercise … due to  venous return. ■ Hormones … (e.g. Adrenaline, noradrenaline, thyroid H). ■ Sleep …  due to  venous return. ■ Pregnancy … due to  metabolism. ■ Smoking ■ Alcohol ■ Family history

Diagnostic * History and physical examination * BP measurement in both arms -Use arm with higher reading for subsequent measurements -BP highest in early morning, lowest at night

INVESTIGATION 1) Urinalysis for glucose, blood , protein 2) Blood urea , Blood glucose level 3) Serum total & HDL cholesterol level 4) ECG 5) Echocardiogram 6) Chest X-ray 7) Renal Ultrasonography

Treatment Goals Overall goals : -Control blood pressure -Reduce CVD risk factors -BP < 140/90 -In patients with diabetes or renal disease, goal is < 130/80 !!

Collaborative Care • Drug Therapy -Diuretics -Adrenergic inhibitors -β - Adrenergic blockers -ACE Inhibitors -Calcium channel blockers

Drug Therapy * Thiazide-type Diuretics -Inhibit NaCl reabsorption -Side effects: * Electrolyte imbalances: ↓ Na, ↓ Cl, ↓ K** (advise K rich foods) * Fluid volume depletion (monitor for orthostatic hypotension) * Impotence, decreased libido

Drug Therapy * Adrenergic Inhibitors -Reduce sympathetic effects that cause HTN by: *Reducing sympathetic outflow *Blocking effects of sympathetic activity on vessels -Side effects : * Hypotension * Varied, depending on specific drug

Drug Therapy * β – adrenergic blockers (suffix “olol”) -(metoprolol, propranolol) -Block β – adrenergic receptors * ↓ HR, ↓ inotropy, reduces sympathetic vasoconstriction) -Side effects : *Bradycardia, hypotension, heart failure, impotence

Drug Therapy *ACE Inhibitors (suffix “pril) -Enalapril, captopril -Prevents conversion of angiotensin I to angiotensin II, thereby preventing the vasoconstriction associate with A II. -Side effects : *Hypotension, cough

Drug Therapy * Calcium Channel Blockers -Block movement of calcium into cells, causing vasodilation -Side effects : * Brdaycardia, heart block

Collaborative Care • Drug Therapy and Patient Teaching - Identify, report, and minimize side effects • Orthostatic hypotension • Sexual dysfunction • Dry mouth • Frequent urination

HYPERTENSION MANAGEMENT IN DENTISTRY

Before initiating dental care Assess presence of hypertension Determine presence of target organ disease Determine dental treatment modifications 1. Asymptomatic BP <159/99 mm Hg, no history of target organ disease No modifications needed Can safely be treated in dental setting 2. Asymptomatic BP 160-179/100-109 mm Hg, no history of target organ disease Assessment on an individual basis with regard to type of dental procedure BP>180/110 mm Hg, no history of target organ disease No elective dental care 3. Presence of target organ disease or poorly controlled diabetes mellitus No elective dental care until BP is controlled, preferable below < 130/80 mm Hg.

Oral Manifestation Of Hypertension There are no recognized manifestations of hypertension but anti-hypertensive drugs can often cause side effects, such as: Xerostomia, Gingival overgrowth, Salivary gland swelling or pain, Taste sense alteration, Paresthesia.