HYPERTENSION

Hypertension is a condition in which arterial blood pressure is chronically elevated.

Hypertension is defined as a systole blood pressure of 140 mm Hg or

greater, or a diastolic blood pressure of 90 mm Hg or greater.

• Hypertension is one of the leading risk factors for CVD, stroke, and end-
stage renal disease.
• It has been estimated that one third of individuals with hypertension
are not aware of their condition and that one-third are not compliant with
prescribed treatment.
• Consequently, dental health care workers may play an important role
in detecting and assisting in managing individuals with hypertension.
• Monitoring vital signs should be a routine component of dental sedation.
• All patients previously identified as having hypertension should be
monitored at each dental appointment.
CLASSIFICATION -JNC-7 Guidelines 2003

Hypertension can broadly be classified

Primary (essential) -95% Secondary- 5%

COMPLICATION
CNS
- Transient ischaemic attacks
- Strokes
- Hypertensive encephalopathy
OPTHALMIC
- Hypertensive retinopathy
CVS
- Left ventricular failure
- coronary artery disease
RENAL
- Protenuria
- progressive renal failure
MALIGNANT HYPERTENSION
- Elevated blood pressure with end organ
damage such us
retinopathy , renal dysfunction and left
ventricular failure may
occur, if left untreated death occurs within
months.
 PRE OPERATIVE MEDICATION &
MANAGEMENT
• Patient BP should be monitored & controlled within normal.

• Hypertension is not diagnosed on a single elevated blood pressure recording,

Rather, classification is based on the average value of three or more blood
pressure readings taken at three or more appointments.
• The first dental office visit should include two blood pressure readings spaced
at least 10 minutes apart, which are averaged and used as a baseline.
• Before the clinician refers a patient to a physician -readings should be taken
at a minimum of two appointments.
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ANTI HYPERTENSIVE DRUGS & ITS
EFFECT
•Individuals who are taking antihypertensive
medication should be considered hypertensive even i
their blood pressure readings are within normal
range.

• The clinician should be aware of the many side

effects of various antihypertensive medications.
• Postural hypotension is very common and can be
minimized by slow positional changes in the
dental chair.
• Nausea, sedation, oral dryness, lichenoid drug
reactions, and gingival overgrowth are associated
with certain classes of antihypertensive agents .
 Hypertension- LA

Ephinephrine( in LA) -is a β and α

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 Hypertension- LA

Monheim 1984:
Dose of 0.04 mg epinephrine has been recommended in patients with cardiovascular
disease

When treating hypertensive patients, the clinician should not use a local anesthetic
containing an epinephrine concentration greater than 1: 100,000, nor should a
vasopressor be used to control local bleeding.

Local anesthesia without epinephrine may be used for short procedures (less than 30
minutes).

Intraligamentary injection is generally contraindicated because hemodynamic changes

are similar to intravascular injection