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    Department of Oral AND Maxillofacial Surgery

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    MNS
    This document discusses hypertension, including its definition, classification, causes, symptoms, complications, investigations, and management. Some key points: - Hypertension is defined as a systolic blood pressure over 140 mmHg or a diastolic over 90 mmHg on repeated exams. It affects over 60 million people. - It is classified as primary (85% of cases, no known cause) or secondary (15% of cases, due to a specific disease). Secondary causes include renal, endocrine, alcohol/drug, and pre-eclampsia. - Management involves general measures like diet, exercise, and lifestyle changes. Drug therapy includes ACE inhibitors, calcium channel blockers, diuretics,

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    Department of Oral AND Maxillofacial Surgery

    Uploaded by

    MNS
    8 views27 pages
    This document discusses hypertension, including its definition, classification, causes, symptoms, complications, investigations, and management. Some key points: - Hypertension is defined as a systolic blood pressure over 140 mmHg or a diastolic over 90 mmHg on repeated exams. It affects over 60 million people. - It is classified as primary (85% of cases, no known cause) or secondary (15% of cases, due to a specific disease). Secondary causes include renal, endocrine, alcohol/drug, and pre-eclampsia. - Management involves general measures like diet, exercise, and lifestyle changes. Drug therapy includes ACE inhibitors, calcium channel blockers, diuretics,

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    Hypertension

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    This document discusses hypertension, including its definition, classification, causes, symptoms, complications, investigations, and management. Some key points: - Hypertension is defined as a systolic blood pressure over 140 mmHg or a diastolic over 90 mmHg on repeated exams. It affects over 60 million people. - It is classified as primary (85% of cases, no known cause) or secondary (15% of cases, due to a specific disease). Secondary causes include renal, endocrine, alcohol/drug, and pre-eclampsia. - Management involves general measures like diet, exercise, and lifestyle changes. Drug therapy includes ACE inhibitors, calcium channel blockers, diuretics,

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as ppt, pdf, or txt
    8 views27 pages

    Department of Oral AND Maxillofacial Surgery

    Uploaded by

    MNS
    This document discusses hypertension, including its definition, classification, causes, symptoms, complications, investigations, and management. Some key points: - Hypertension is defined as a systolic blood pressure over 140 mmHg or a diastolic over 90 mmHg on repeated exams. It affects over 60 million people. - It is classified as primary (85% of cases, no known cause) or secondary (15% of cases, due to a specific disease). Secondary causes include renal, endocrine, alcohol/drug, and pre-eclampsia. - Management involves general measures like diet, exercise, and lifestyle changes. Drug therapy includes ACE inhibitors, calcium channel blockers, diuretics,

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    of 27

    DEPARTMENT OF ORAL

    AND
    MAXILLOFACIAL SURGERY
    HYPERTENSION
    A PERSISTENT ELEVATION OF
    BLOOD PRESSURE ABOVE VALUES
    NORMATIVE FOR AGE MEASURED
    ON REPEATED EXAMINATIONS

    SYSTOLIC> 140mmHg
    DIASTOLIC> 90mmHg
    NORMAL VALUES
    140/90mmHg at 20yrs
    160/95mmHg at 50yrs
    170/105mmHg at 75yrs
    Hypertension
    - elevation of diastolic pressure
    - affects over 60 million
    - 2-3 fold risk of coronary artery

    disease
    -- 90-110mmHg
    8 fold risk of stroke
    : Mild
    110-130mmHg : Moderate
    >130mmHg : Severe
    CLASSIFIED AS
    Primary/essential hypertension
    - 85% cases
    - no specific cause
    - positive family history
    Secondary hypertension
    - 15% cases
    - consequence of specific
    disease/ abnormality
    ETIOLOGY OF SECONDARY
    HYPERTENSION
    Coarctation of aorta
     Renal causes
     Endocrine causes
     Alcohol and drugs
     Pre eclamptic toxaemia
    Systolic hypertension is due to
    Atherosclerosis
    Exercise, Fever
    Anaemia, Thyrotoxicosis
    Large A-V fistulas
    Diastolic hypertension is due to
    Elevated total peripheral
    resistance
    Clinical features
     Majority are asymptomatic
     Headache, polyuria
     Palpitations, dizzyness
     Epistaxis, haematuria
     Recurrent backpain
     Undiagnosed fever
     Left ventricular hypertrophy
     Left atrial hypertrophy
     Fourth heart sound
     Early diastolic murmur
     Fundal changes
    COMPLICATIONS
     CNS
    Ischaemic attacks
    Stroke
    Subarachnoid haemorrhage
    Hypertensive
    encephalopathy
     Ophthalmic
    Hypertensive
    retinopathy
    GRADING :
    Grade 1- Arteriolar narrowing and
    increase in light reflex
    Grade 2- Grade 1+ A-V nipping
    Grade 3- Grade 2+ flame shaped
    haemorrhages, soft
    exudates
    Grade 4- Grade 3+ papilloedema
     CVS
    Coronary artery disease
    Left ventricular failure
    Aortic aneurysm
    Aortic dissection

     RENAL
    Proteinuria
    Progressive renal failure
    INVESTIGATIONS
    Urine analysis
    Blood urea and creatinine
    Serum electrolytes
    Blood glucose
    Serum cholesterol
    Serum Ca , Uric acid
    ECG
    Chest radiograph
    MANAGEMENT
    1. General measures
    2. Anti hypertensive drug
    therapy
    3. Treatment of underlying
    cause
    GENERAL MEASURES
    • Reassurance
    • Control of obesity
    • Low sodium diet
    • Moderate smoking, alcohol
    consumption
    • Regular exercises
    • Meditation
    ANTI-HYPERTENSIVES

    1. ACE Inhibitors
    Captopril, Enalapril, Lisinopril,
    Perindopril, Ramipril

    2. Angiotensin Antagonist
    Losartan
    3. Calcium Channel Blockers
    Verapamil, Diltiazem, Nifedipine,
    Felodipine, Nitrendipine, Lacidipine

    4. Diuretics
    Hydrochlorothiazide
    Chlorthalidone
    Furosemide
    Spironolactone
    Amiloride, etc.
    5. Beta Adrenergic Blockers
    Propranolol
    Atenolol
    Metaprolol,etc

    6. Alpha Adrenergic Blockers


    Prazosin
    Phentolamine, etc
    7. Central sympatholytics
    Clonidine
    Methyldopa

    8. Vasodilators
    Hydralazine
    Minoxidil, etc
    RECOMMENDED DRUG DOSAGES
    Propranolol- 40mg BDS TO 160mg
    6 hourly
    Atenolol - 50-100mg once daily
    Metaprolol - 50mg BDS
    Captopril - 6.25mg
    Nifedipine - 10-20mg TDS
    Verapamil - 180-360mg/ day in
    divided doses
    Clonidine - 0.1-1mg daily
    DENTAL CONSIDERATIONS
    A) Detailed history

    B) Measure the patient’s blood


    pressure
    C) Medical opinion
    D) Prefer early morning short time
    appointments
    E) Anti anxiety measures

    F) Use LA with vasoconstrictors to


    avoid pain, anxiety and tachycardia

    G) Always aspirate before injection


    and do not use more than 4 cartridges
    of LA
    I) Local measures to control bleeding
    - sutures
    - cotton pack
    - bone wax, oxidised cellulose
    - styptics
    J) Prevent postural hypotension
    K) In emergency conditions, use
    - Sodium nitroprusside
    - Glyceryl trinitrate i.v
    - Esmolol slow i.v
    THANK YOU

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