Hypertension in exodontia (2) /certified fixed orthodontic courses by Indian dental academy

HYPERTENSION IN
EXODONTIA

www.indiandentalacademy.com

INDIAN DENTAL ACADEMY
Leader in continuing dental
education


CONTENTS
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Definition
Types
Causes
Signs
Target organ diseases
Investigation
General Management
Dental aspect of hypertension
Conclusion
References

 Increase in blood pressure

 It is a traitor opposed to a specific disease

and represent a quantitative rather than a
qualitative deviation from the norm, hence
any definition is arbitrary


Types

Hypertension

Essential

Secondary


White collar

Causes

Idiopathic

Secondary

Idiopathic
 40-60% is genetic factor
 High salt intake
 Heavy consumption of alcohol
 Obesity
 Lack of exercise
 Impaired intrauterine growth
 Stress

Secondary
 Alcohol

 Pregnancy

 Renal disease

–
–
–
–
–

Renal artery disease
Pyelonephritis
Glomerulonephritis
Polycystic disease
Post trasnplant

 Coarctation of aorta


Secondary causes contd.


Endocrine disease
–
–
–
–
–



Pheochromocytoma
Cushings syndrome
Acromegaly
Thyrotoxicosis
Hyperaldosteronism

Cerebral disease

– Cerebral oedema (stroke, head injuries & tumours)



Drugs
–
–
–

Oral contraceptives
Streroids
NSAIDS

Signs
 Paroxysmal headache
 Palpitation
 Sweating
 Breathlessness
 Angina


Target organ disease
Blood vessels

Central nervous system
Retina
Heart
Kidneys
Malignant or
accelerated phase hypertension

Blood vessels

Larger arteries

Smaller arteries


Larger arteries
(Over 1mm in dia)
↓
Internal elastic lamina is thickened
↓
Smooth muscle hypertrophy
↓
Fibrous tissue is deposited
↓
Vessels dilate become tortous, walls become less compliant
↓
Aggravates hypertension by increasing peripheral vascular
resistance
↓
Aortic aneurysm & dissection, coronary & cardiovascular
disease, renal failure

Smaller arteries
↓
Hyaline arteriosclerosis in the wall
↓
Lumen narrows
↓
aneurysm develops
↓
Aggravates hypertension by increasing peripheral
vascular resistance
↓
Aortic aneurysm & dissection, coronary &
cardiovascular disease, renal failure

Central nervous system



Stroke due to cerebral hemorrhage or infarction



Carotid atheroma & transient cerebral ischemia attacks
are common



Subarachnoid haemorrhage



Symptoms are
–
–
–
–



Disturbance of speech or vision
Paraesthesia
Disorientation
Fits & loss of consiousness

Neurologial deficit is usually reversible if the
hypertension is controlled

Retina
 Central retinal vein thrombosis occurs

 Micro aneurysm also occurs


Heart
High blood pressure

Left ventricular hypertrophy
(atrial fibrillation)


Left ventricular failure

Kidney
 Proteinuria

 Progressive renal failure by damaging the

renal vasculature


Malignant or accelerated phase
hypertension
 This rare condition may complicate

hypertension of etiology and is
characterized by damage with necrosis in
the walls of small arteries & arterioles


Investigations

For all patients

Selected patients


Investigations for all patients
 Urine analysis for blood, protein and

glucose
 Blood urea, electrolyte, and creatinine
 Blood glucose
 Serum total and high density lipoprotien
 12 lead ECG


Investigations for selected patients
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Chest radiograph
Ambulatory BP recording
Echocardiogram
Renal ultrasound
Renal angiography
Urinary catecholamines
Urinary corstiol and dexamethasone supressing
test
Plasma renin activity and aldosterone

Management

Non-drug therapy


Drug therapy

Non drug therapy
 Correct obesity

 Reducing alcohol intake
 Restricting salt intake

 Regular physical exercise

 Increasing consumption of fruits and

vegetables
 Quitting smoking
 Eating oily fish


Drug therapy


ß adrenoreceptor blockers
–
–
–
–
–
–
–



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Metaprolol (100-200mg/day)
Bisoprolol (50-100mg/day)
Atenolol(50-100mg/day)
Labetalol (200-2.4g/day)
Dry mouth
Lichenoid reactions
Paresthesia with labetalol

–
–
–
–
–

Contraindicated in asthma
Avoid in heart failure/block
Muscle weakness
Lassitude
Disturbed sleep www.indiandentalacademy.com

Possible oral effects

Other adverse effects

Vasodilators
 Prazosin (0.5-20mg/day)
 Indoranmin (20-100mg/day)
 Hydralazine (25-100mg/day)
 Minxidil (10-50mg/day)
 Adverse effects

– Headache
– Hypertrichosis
– oedema

ACE inhibitors
–
–
–
–
–
–
–
–





Captopril (25-75 mg/BD)
Enalapril (20mg/day)
Ramipril (5-10 mgdaily)
Lisinopril (10-20 mg /day)
Sinusitis
Lichenoid reaction
Loss of taste
Burning sensation

–
–
–
–

Sudden fall in bp
Impair renal function
Cough
Angioedema

Possible oral effects

Adverse effects


Calcium channel blockers
– Nifidipine (30-90mg/day)
– Verapamil (240mg/day)
 Oral effects

– Gingival hyperplasia
– Salivation
 Adverse effects

– Headache and flushing
– Swollen legs

Dental aspects
 Pre operative evaluation

 Management guidelines


Pre operative evaluation


Determine
–
–
–
–



Electrolyte
Creatinine
BUN
Hypokalemia

–
–
–
–
–

Status of therapy
Papilledema
Retinal hemorrages
Heart failure
Cardiac enlarge maent

Asses the complications


Management guidelines
 Untreated mild or moderate hypertension

–
–
–

Diastolic- 90-110 mg hg
Bp should be monitored
Medication should be used pre and post
operatively

 Controlled hypertnsion

– Therapy should be maintained untill the night
before surgery
– Medication to be known to anaesthesiologist
– Potassium preoperative to be given

 Moderate to severe hypertension

–
–
–
–
–

Diastolic greater than 110mm hg
Rapidly acting agents can be given
Emergency- nitriprusside or nitroglycerine
I.v methydopa or diazoxide
Oral prazosin or clonidine


General anesthesia
 Contraindications

–
–
–
–

Severe hypertension
Cardiac failure
Coronary / cerebral artery insufficiency
Renal insufficieny

 Best treated under LA
 Diuretics should be stopped before

surgery


Conclusion


References


Thank you
Leader in continuing dental
education


Hypertension in exodontia (2) /certified fixed orthodontic courses by Indian dental academy

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Hypertension in exodontia (2) /certified fixed orthodontic courses by Indian dental academy