Hypertension

DONE BY: RAHMA SAMIR •

SUPERVIZED BY: SUHAD JUMAH •

‫• المركزالصحي التخصصي لطب األسنان الشيخ عمر (وحدة‬

)‫الفحص‬
10/2/2011 •
 Hypertension

It is abnormal elevation of the arterial

blood pressure. it remain asymptomatic
for long period of time but later on lead
to damage and symptoms on several
organ
 Classification of blood
pressure expressed in mm Hg

Normal Systolic lower than120,diastolic lower than -1

80
prehypertension syst.120-139 ,dias.80-99 -2
stage1-syst.140-159 ,dia90-99-3
stage2-systolic equal or more than160 diastolic -4
equal or more than100
The accepted B.P of dias is90 and syst is 140 greater
than is abnormal
 Types of hypertension
there are 2 type of hypertension
Essential hypertension-1
The exact cause of which is undetermined it is
prevalence about 95%
Secondary hypertension it is prevalence-2
-:about 5% due to
a-alcohol
b-pregnancy
c-renal disease
d-endocrine disease
e-drugs
e.g. oral contraceptive containing
estrogen
corticosteroid, and non steroidal,
anti inflammatory drugs
f- coarctation of aorta due to
atherosclerosis
g-neurogenic problem
 Symptoms of hypertension
occipital headache-1
vision change-2
ringing ear-3
dizziness-4
left ventricular hyperatrophy-5
 The adverse effect of untreated
hypertension cause damage in several organs
include
Brain.cause cerebrovascul accidint-1
And stroke due to cerebral hemorrhage or cerebral infarction
In eye cause blindness-2
In kidneys cause proteinuria and renal failure-3
In heart cause left ventricular hyperatrophy ,atrial-4
fibrillation,myocardial infarction and congestive heart failure
Investigations of
hypertension
Urinanalysis for blood ,protein and glucose-1
Blood urea ,electrolyte creatinine-2
Blood glucose-3
Serum total and high density lipoprotein HDL-4
cholesterol
ECG electrocardiography for left ventricular-5
hyperatrophy and coronary artery disease
Treatment of hypertension
Non drug treatment-1
a-correction of obesity
b-reduce alcohol intake
c-restricting salt intake
d-regular physical exercise
e-increase consumption of fruit and vegetables
Antihypertensive drugs

thiazide and other diuretics e.g bendrofluside-1

Beta-adrenoceptor antagonist e.g-2
metroprolol,atenolol,labetolol
Angiotensin converting enzyme ACE inhibitor-3
.e.g captopril,rampril,lisinopril
Angiotensin II receptor antagonists e.g-4
losartan,valsartan
,Calcium antagonists e.g nifedipine-5
The Dental Managment
it is essential to identify uncontrolled or-1
undiagnosed hypertensive patient befor dental
procedure and refere him to physicion because the
stress and anxiety related to dental procedure
cause elevation of B.P leading to serious
complication such as C.V.A OR M.I
B.P should be monitored preoperatively-2
the dentist should know the type of anti-3
hypertensive drug used by the patient because
some of these drugs may have an interaction with
vasoconstrictor (adrenaline) present in local
anaesthesia such as MAO inhibitors.
4-if the patient have sever and uncontrolled
hypertension
a_ avoid any routine dental treatment
b- if the patient needs an emergency dental
treatment then just prescribe antibiotic for control
.of infection and analgesic for control of pain
.
if the patient is well controlled and under good medical -5
care :-
then you can do any routine dental treatment taking in
consideration the following precautions
a- reduce the stress &anxiety for the patient and this could
be obtained by :-
1-encourage the patient.
2-avoid long or streessful appointment .
3-use premedication such as valium2-5 mg the night or
one hour befor dental treatment.
4- avoid stimulation of gag reflex
if the patient is over stressed,then stop the dental treatment and -5
terminate the appointment
6- we can use nitrous oxide when needed, but avoid hypoxia
b- the local anaesthesia:-
we can use xylocaine 2% with adrenaline 1/100 000 but we have to
use aspirating syringe to avoid the intravascular injection ,also we
should not use more than 3 carpoules
note:- if the aspirating syringe is not available ,then you can use
citanest or plain anesthesia
c- avoid change the chair position suddenly because it may lead to
.orthostatic hypotension