1. Hypertension

2. The pathogenesis of essential hypertension is multifactorial and complex. [13]Multiple factors modulate the blood pressure (BP) including humoral mediators, vascular reactivity, circulating blood volume, vascular caliber, blood viscosity, cardiac output, blood vessel elasticity, and neural stimulation. A possible pathogenesis of essential hypertension has been proposed in which multiple factors, including genetic predisposition, excess dietary salt intake, and adrenergic tone, may interact to produce hypertension. 

3. Globally, an estimated 26% of the world’s population (972 million people) has hypertension, and the prevalence is expected to increase to 29% by 2025, driven largely by increases in economically developing nations. Regarded as a primary contributor to heart disease and stroke, the first and third leading causes of death worldwide, respectively.

4. Normal: Systolic lower than 120 mm Hg, diastolic lower than 80 mm Hg
Based on recommendations of the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7), the classification of BP for adults aged 18 years or older has been as follows  :
Normal: Systolic lower than 120 mm Hg, diastolic lower than 80 mm Hg
Prehypertension: Systolic mm Hg, diastolic mm Hg
Stage 1: Systolic mm Hg, diastolic mm Hg
Stage 2: Systolic 160 mm Hg or greater, diastolic 100 mm Hg or greater

5. Arterial Hypertension as a risk factor
Hypertension is a highly prevalent risk factor for cardiovascular disease
Hypertension plays a major etiologic role in the development of cerebrovascular disease, ischemic heart disease, cardiac and renal failure

6. Laboratory and instrumental investigation- routine tests
Serum total cholesterol, LDL, HDL
Fasting serum triglycerides
Fasting plasma glucose
Serum potassium
Serum uric acid
Serum creatinine
Haemoglobin and haematocrit
Urinalysis
Electrocardiogram
Echocardiogram

7. Secondary causes of AH Renal parenchymal disease (most common cause)
Renovascular hypertension (2nd most common cause)
Pheochromocytoma
Primary hyperaldosteronism
Cushing’s syndrome
Obstructive sleep apnea
Coarctation of aorta
Drug-induced hypertension

8. Benefits of Lowering BP
Average reduction
Stroke incidence 35–40%
Myocardial infarction 20–25%
Heart failure >50%

9. Aim of antihypertensive therapy
The primary goal of treatment is to achieve
(< 140/90 mm Hg) and treatment of all reversible risk factors are indicated
In diabetes and in high risk patients BP target should be at least < 130/80 mmHg

10. Lifestyle changes smoking cessation weight reduction
reduction of alcohol intake
physical exercise
reduction of salt intake
increase in fruit and vegetables intake
decrease in saturated and total fat intake

11. Antihypertensive drugs
thiazide diuretics
calcium antagonists (CA)
ACE-inhibitors (ACEI)
angiotensin receptor blockers (ARB)
beta-blockers (BB)

12. Dental Aspect
SBP< 140,DBP < 90 (I) Routine dental care SBP=140–159,DBP=90–99 (II) Recheck BP before starting routine dental care SBP=160–179,DBP=99–109 (III) Recheck BP and seek medical advice before routine dental care Restrict use of adrenaline/ epinephrine Conscious sedation may help

13. SBP> 180,DBP > 110 (IV) Recheck BP after 5 min quiet rest
SBP> 180,DBP > 110 (IV) Recheck BP after 5 min quiet rest. Medical advice before dental care Only emergency care until BP controlled Avoid vasoconstrictors

14. An aspirating syringe should be used to give a LA, since epinephrine (adrenaline) in the anaesthetic given intravenously may (theoretically) increase hypertension and precipitate arrhythmias

15. Corticosteroids may raise the blood pressure and antihypertensive treatment may have to be adjusted accordingly. Some NSAIDs (indometacin, ibuprofen and naproxen) can reduce the efficacy of antihypertensive agents.

16. Antihypertensive drugs can sometimes cause orofacial side-effects, such as xerostomia, salivary gland swelling or pain, lichenoid reactions, erythema multiforme, angioedema, gingival swelling, sore mouth or paraesthesiae

17. Thanks