Hypertension

Question 1

What is Hypertension?

Answer 1

Abnormally high BP measured at 140/ 90 mm Hg or higher.

Question 2

What is mm Hg?

Answer 2

Millimetres of mercury, measuring unit for BP

Question 3

What is the optimal BP?

Answer 3

< 120 / 80 mm Hg

Question 4

What is normal BP?

Answer 4

< 130 / 85 mm Hg

Question 5

What is borderline BP?

Answer 5

130-139/ 85-89 mm Hg

Question 6

What is Stage I BP?

Answer 6

140-159/ 90-99 mm Hg

Question 7

What is Stage II BP?

Answer 7

160-179/ 100-109 mm Hg

Question 8

What is Stage II BP?

Answer 8

> 180/ >110 mm Hg

Question 9

Prevalence of Hypertension?

Answer 9

20% of population

Question 10

Etiology of Hypertension?

Answer 10

Idiopathic. But most commonly seen in: 1. older patients 2. If over 50 = family hx, 3. Mild hypertension

Question 11

Symptoms of HPT?

Answer 11

Asymptomatic

Question 12

Signs of HPT?

Answer 12

Measured BP of 140/ 90 mm Hg

Question 13

Tx - Non-pharmacological

Answer 13

1. Limit Salt Intake
2. Weight Loss
3. Regular Exercise
4. Limit Alcohol
5. Smoke Cessation

Question 14

Tx - Pharmacological (list 1st - last line of treatment)

Answer 14

1. Diuretics
2. ACE Inhibitor/ ARB
3. CCB
4. Beta Blockers
5. Miscellaneous

Question 15

Mechanism of action of diuretics?

Answer 15

Diuretics are drugs that increase flow of urine. AKA - diuretics are agents that decrease extracellular fluid volume. This happens by the following mechanisms:

1. inhibition of an active transport process
2. alteration of epithelial ion permeability
3. inhibition of energy-producing processes in cells
4. alteration or intrarenal hemodynamics
5. antagonism of endogenous hormones

Notes from 2011 Dents: decreases plasma volume > decreases Na and K

Question 16

List 3 diuretics

Answer 16

1. Hydrochlorthiazide
2. Chlorthalidone
3. Indapamide

Hint - chlor

Question 17

What does ACE [inhibitor] stand for?

Answer 17

Angiotensin-converting enzyme [inhibitor]

Question 18

Mechanism of ACE inhibitors

Answer 18

Decrease preload and afterload = vasodilation = can cause cough in 15% of pts.

Hint - pril

WIKI mechanism: ACE inhibitors inhibit angiotensin-converting enzyme (a component of the blood pressure-regulating renin-angiotensin system), thereby decreasing the tension of blood vessels and blood volume, thus lowering blood pressure.

Question 19

List 4 ACE inhibitors?

Answer 19

1. Captropril
2. Enalapril
3. Perindopril
4. Ramipril

Question 20

What does ARB stand for?

Answer 20

Angiotensin Receptor Blocker

Question 21

Mechanism of ARBs

Answer 21

ARBS are used when pt is intolerant of ACE inhibitor therapy. Pts intolerant to ACE inhibitor therapy don’t inhibit the breakdown of bradykinin (along with other kinins) thus associate with persistent dry cough or angioedema which limit ACE inhibitor therapy.

Mechanism same as ACE I. - Decrease preload and afterload = vasodilation

Question 22

List 4 ARBs

Answer 22

1. Losarten
2. Olmesartan
3. Valsartan
4. Telmisartan

Hint - sartan

Question 23

Mechanism of beta blockers

Answer 23

Blocks beta receptors > decreases BP and HR

Question 24

List 4 beta blockers

Answer 24

1. Metoprolol
2. Atenolol
3. Propanolol
4. Bisoprolol

Hint - olol

Question 25

What does CCB stand for

Answer 25

Calcium Channel Blockers

Question 26

Mechanism CCB?

Answer 26

Decrease rate and contractility, vasodilatory (peripheral, coronary and pulmonary)

Question 27

List 5 CCB

Answer 27

1. Verapamil 2. Amlodipine 3. Nifedipine 4. Diltiazem 5. Felodipine Hint - dipine

Question 28

Miscellaneous drugs used to treat hypertension

Answer 28

1. Clonidine 2. Minoxidil 3. Methyldopa 4. Spironolactone *Dont treat pt if they are on these, red flag

Question 29

General Dental Considerations

Answer 29

1. Review frequency and results of BP monitoring 2. Review med list 3. Ask about complications from HPT

Question 30

Dental considerations day of surgery

Answer 30

1. Ask pt to anti-hypertensive therapy meds day of surgery 2. be mindful that emotional stress/ pain can elevate BP 3. change in position can precipitate hypotension 4. minimize the use of vasopressors (vasoconstrictor) 5. AVOID surgery if HPT is 180/ 110 or more or symptomatic