| Aspect | Explanation |
|---|---|
| Synopsis | – Hypertension can lead to severe health complications such as heart disease, stroke, and kidney failure. It is often called a “silent killer” because it typically has no symptoms until significant damage has occurred. |
| Signs and Symptoms | – Often asymptomatic in early stages. – Headaches, particularly in the morning. – Nosebleeds. – Shortness of breath. – Chest pain. – Dizziness. – Visual changes. |
| Appropriate Management in the Dental Clinic | – Measure blood pressure at the start of each visit. – Schedule short, morning appointments to minimize stress. – Encourage stress reduction techniques, such as deep breathing or listening to calming music. – Ensure adequate local anesthesia to prevent pain-induced spikes in blood pressure. |
| Precautions | – Drugs to Avoid: Avoid NSAIDs as they can increase blood pressure and reduce the effectiveness of antihypertensive medications. – Issues with Local Anesthesia: Use local anesthetics with vasoconstrictors (like epinephrine) cautiously. Limit the dose to avoid significant increases in blood pressure. – Position of the Chair: Avoid sudden changes in chair position to prevent orthostatic hypotension. |
| Can they be seen in the dental clinic and when not | – Can be seen with caution: Patients with well-controlled hypertension (typically under 140/90 mmHg) can generally be treated safely with appropriate precautions. – Should not be seen and require immediate medical attention: Patients with severely elevated blood pressure (e.g., 180/110 mmHg or higher) should be referred for immediate medical evaluation and not treated until their condition is stabilized. |
| Drug Contraindications | – NSAIDs (e.g., ibuprofen, naproxen): Can aggravate hypertension. – Decongestants (e.g., pseudoephedrine): May increase blood pressure and should be avoided. – Certain Antibiotics (e.g., erythromycin, clarithromycin): May interact with some antihypertensive medications. Always consult the patient’s physician before prescribing new medications. Local Anesthetics with High Epinephrine: Use the lowest effective dose to minimize cardiovascular effects. |
| Sources | – UpToDate: Hypertension in adults: Overview of management. – American Heart Association: Guidelines for the prevention and treatment of hypertension. – National Institute for Health and Care Excellence (NICE): Hypertension in adults: diagnosis and management. |
Classification of Blood Pressure and Dentist Guidelines
| Category | Systolic Pressure (mmHg) | Diastolic Pressure (mmHg) | Dentist Guidelines |
|---|---|---|---|
| Normal | <120 | <80 | Can be seen |
| Elevated | 120-129 | <80 | Can be seen with monitoring |
| Hypertension Stage 1 | 130-139 | 80-89 | Can be seen with caution, monitor BP |
| Hypertension Stage 2 | ≥140 | ≥90 | Evaluate risks, can be seen if adequately managed |
| Hypertensive Crisis | >180 | >110 | Should not be seen, refer for immediate medical evaluation |
Updated Classification of Hypertension
| Systolic Pressure (mmHg) | Diastolic Pressure (mmHg) | 2017 ACC/AHA Classification |
|---|---|---|
| < 120 | < 80 | Normal Blood Pressure |
| 120–129 | < 80 | Elevated Blood Pressure |
| 130–139 | 80–89 | Stage 1 Hypertension |
| 140–159 | 90–99 | Stage 2 Hypertension |
| ≥ 160 | ≥ 100 | Stage 2 Hypertension |
Notes:
- Classification criteria: Should be based on an average of ≥ 2 readings on ≥ 2 occasions in a standardized environment.
- White coat hypertension: Persistent elevated blood pressure in a clinical setting with no previous elevated reading over a 24-hour period. Confirmed with:
- Home blood pressure readings of ≤ 135/85 mmHg
- 24-hour ambulatory readings of ≤ 130/80 mmHg
