• Hypertension is a common cardiovascular
disease affecting worldwide population.
• A persistent and sustained high blood pressure
has damaging effects on the heart, brain, kidneys
1. Primary or essential hypertension: It is the most
common type. There is no specific underlying
2. Secondary hypertension: It can be due to renal,
vascular, endocrine disorders, etc.
• Systolic blood pressure (SBP): It is the maximum
pressure recorded during ventricular systole.
• Diastolic blood pressure (DBP): It is the
minimum pressure recorded during ventricular
• Pulse pressure (PP): It is the difference between
systolic and diastolic blood pressure
(PP = SBP –DBP)
• It is characterized by a very high blood
pressure (systolic >220 and/or diastolic >120
mmHg) with progressive end-organ damage
such as renal dysfunction and/or hypertensive
• The BP should be reduced by not more than
25% within minutes to 2 h, and then to
160/100 mm of Hg within 2–6 h.
• The preferred drug to treat the condition is
sodium nitroprusside (i.v. infusion).
• The other drugs :
– nitroglycerin (i.v. infusion)
– hydralazine (i.v.)
– labetalol (i.v.)
• Angina pectoris is a symptom of ischaemic heart
disease. It is due to an imbalance between oxygen
supply and oxygen demand of the myocardium.
Types of angina pectoris
• Stable angina (classical angina): It is characterized by
episodes of chest pain commonly associated with
• Unstable angina: It is characterized by angina at rest or
increased frequency and duration of anginal attacks.
– due to rupture of an atheromatous plaque and platelet
deposition in the coronary artery, leading to progressive
• Prinzmetal’s angina (variant angina): Angina that
occurs at rest and is due to spasm of coronary arteries.
Angina occurs due to imbalance in oxygen
supply and demand by the myocardium.
• For an acute attack, nitroglycerin is commonly administered
sublingually with an initial dose of 0.5 mg, which usually relieves
pain in 2–3 min.
• Patient is advised to spit out the tablet as soon as the pain is
relieved to avoid side effects (hypotension and headache).
• If the pain is not relieved, the tablet can be repeated after 5 min;
but not more than three tablets in 15 min.
• If pain is not relieved, it could be MI. Give tablet aspirin 325 mg
orally, oxygen by face mask, then refer the patient to cardiologist.
CONGESTIVE CARDIAC FAILURE
• The function of the heart is to pump an adequate
amount of blood to various tissues.
• In CCF, there is an inadequate contraction of the
heart leading to reduced cardiac output (CO).
• The compensatory mechanisms that try to
maintain the cardiac output are:
• Increased sympathetic activity.
• Increased renin–angiotensin–aldosterone activity.
• Myocardial hypertrophy.
• As time progresses, the compensatory
mechanisms fail and gradually clinical
symptoms of failure appear.
• The basic haemodynamic disturbances seen
in congestive cardiac failure are:
– Pulmonary edema which is characterized by
– Decreased cardiac output leading to peripheral
edema, tissue hypoxia.
CONGESTIVE CARDIAC FAILURE
• Nina is 56 years old and has been coming to your practice for close
to 15 years. Until recently, she would take only acetaminophen for
an occasional headache. Mrs. Nina went to the doctor last week for
her annual check-up. She had not been “feeling herself ” for the last
several months. Upon examination, Mrs. Nina learned that she has
hypertension and elevated cholesterol values. Life has not been the
same since. Mrs. Nina started having some chest pain, which was
attributed to anxiety regarding her diagnosis. Now, in addition to
acetaminophen, Mrs. Nina is taking lisinopril and
hydrochlorothiazide to treat hypertension and atorvastatin to treat
• What is lisinopril and what is its role in the treatment of
• Are there any dental concerns associated with lisinopril?
• What are the dental concerns associated with antihypertensive
therapy? Counsel the patient about them.
Xerostomia. Dry mouth is an adverse reaction associated with several of the antihypertensives. If the dental health care worker notices this effect, it is imperative to discuss with the patient methods used to alleviate this discomfort. Dysgeusia. With some antihypertensives, an altered sense of taste may occur, which may be related to xerostomia. Gingival enlargement. CCBs have the ability to produce gingival enlargement. Meticulous oral hygiene and frequent recall appointments may minimize this effect. Orthostatic hypotension. When a patient has been in a supine position and suddenly rises to an upright position, a sudden drop in blood pressure may occur. This side effect is called orthostatic hypotension. Patients taking antihypertensive agents who have been supine for some time should be slowly raised from that position. They should dangle their legs over the side of the chair or bed and wiggle them before rising to the standing position. The patient should be supported for a few steps to prevent syncope. Guanethidine causes this problem often; other agents produce variable amounts of orthostatic hypotension. Constipation. Some antihypertensive agents (e.g., verapamil) can cause constipation, which could be additive with the constipation produced by the opioids. An increase in dietary fiber, a bulk laxative, or a stool softener may be considered if an opioid is prescribed for a patient receiving a constipation-producing antihypertensive medication. Central nervous system sedation. Several antihypertensives (β-blockers, methyldopa) can produce sedation, which is additive to effects of other CNS depressants such as opioids or benzodiazepines
Dental Drug Interactions Nonsteroidal antiinflammatory drugs. NSAIDs, especially indomethacin, can reduce the antihypertensive effect of the α1-blockers (Box 14-7). They produce this effect by inhibiting renal prostaglandin synthesis or causing sodium and fluid retention. Epinephrine. The sympathomimetics can increase the antihypertensive effects of doxazosin. The α1-blockers prevent the α1-agonist effects (vasoconstriction) of epinephrine, leaving the β1- and β2-agonist effects (vasodilation) to predominate. The combined vasodilation can result in severe hypotension and reflex tachycardia.
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