Hypertension in dental practice

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Information about Hypertension in dental practice

Published on May 30, 2014

Author: vdrao1

Source: authorstream.com

PowerPoint Presentation: Hypertension in Dental Practice Dr V Dharma Rao Professor of Medicine Mamata Medical College Khammam , Andhra Pradesh PowerPoint Presentation: Definition Systolic BP ≥ 140 mm Hg Or Diastolic BP ≥ 90 mm Hg PowerPoint Presentation: “The greatest danger to a man with high blood pressure lies in its discovery, because then some fool is certain to try and reduce it.” Historical Comments about Hypertension Hay, Brit Med J, 1931 HYPERTENSION: HYPERTENSION It is commonest CVD It is a major RF for CV mortality, CHD, CVA, CHF, and RF The relationship between BP and risk of CVD events is continuous, consistent, and independent of other RFs. The higher the BP the greater the chance of heart attack, HF, stroke, and kidney diseases. HYPERTENSION: In EMR it affects about 25% of adult population About 75% of hypertensive individuals are unaware of being diseased About 50% of hypertensive patients who knew they are diseased are either not on treatment or taking treatment but not controlled. HYPERTENSION PowerPoint Presentation: Why do we treat hypertension? Objective measurement we can modify….but Reduce cardiovascular risk Reduce all cause morbidity and mortality Reduce the incidence and progression of left ventricular hypertrophy Prevention of atherosclerosis, retinopathy, renal failure, etc. The Problem: The Problem Modern Life Has Both Conveniences…..: Modern Life Has Both Conveniences….. Illustration taken from: Lambert C, Bing C. The Way We Eat Now. Harvard Magazine . May-June, 2004;50. PowerPoint Presentation: ……. and Costs PowerPoint Presentation: Classification of severely elevated blood pressure Frequency Distribution of Untreated HTN by Age: Frequency Distribution of Untreated HTN by Age Isolated Systolic HTN Isolated Diastolic HTN Systolic Diastolic HTN PowerPoint Presentation: General population aged 60 years or older SBP ≥150 mmHg Or DBP ≥ 90mmHg Goal of Treatment : SBP <150 mmHg OR DBP of < 90mmHg. Initiate Treatment at : PowerPoint Presentation: General population < 60 years Initiate Treatment at : DBP ≥ 90mmHg Goal of Treatment : DBP of < 90mmHg. PowerPoint Presentation: General population < 60 years S BP ≥ 140 mmHg Goal of Treatment : S BP of < 140 mmHg . Initiate Treatment at : PowerPoint Presentation: P opulation aged 18 years or older with CKD Initiate Treatment at: SBP ≥ 140 mmHg Or DBP ≥ 90 mmHg Goal of Treatment : SBP < 140 mmHg Or DBP < 90 mmHg PowerPoint Presentation: Population aged 18 years or older with diabetes Initiate Treatment at: SBP ≥ 140 mmHg Or DBP ≥ 90 mmHg Goal of Treatment : SBP < 140 mmHg Or DBP < 90 mmHg Concerning selection of antihypertensive drugs.: Concerning selection of antihypertensive drugs. PowerPoint Presentation: In General nonblack population, including those with diabetes Initial antihypertensive treatment should include any of the following: A thiazide-type diuretic Calcium channel blocker ( CCB) Angiotensin-converting enzyme inhibitor ( ACEI) or Angiotensin receptor blocker (ARB ). PowerPoint Presentation: In general black population, including those with diabetes : I nitial antihypertensive treatment should include : Thiazide-type diuretic CCB . PowerPoint Presentation: Population aged 18 years or older with CKD and hypertension Initial ( or add-on) antihypertensive treatment should include an ACEI or ARB to improve kidney outcomes . This applies to all CKD patients with hypertension regardless of race or diabetes status . PowerPoint Presentation: The main objective of hypertension treatment is to attain and maintain goal BP. If goal BP is not reached within a month of treatment: increase the dose of the initial drug OR Add a second drug from one of the classes in recommendation 6 ( thiazide-type diuretic , CCB, ACEI, or ARB). The clinician should continue to assess BP and adjust the treatment regimen until goal BP is reached . PowerPoint Presentation: If goal BP cannot be reached with 2 drugs: Add and titrate a third drug from the list provided. Do not use an ACEI and an ARB together in the same patient . If goal BP cannot be reached using the drugs in recommendation 6 because of a contraindication or the need to use more than 3 drugs to reach goal BP: antihypertensive drugs from other classes can be used. PowerPoint Presentation: Blood Pressure: 150/94 Can we go ahead with our procedure? “I think it’s OK” Wait for medicine/cardiology to confirm? How should it/might it affect your anaesthetic plan? Delay case? Cancel case? Proceed based upon previous experience? Consult with other team member & proceed accordingly? PowerPoint Presentation: Reason for evaluation Anesthesia and surgery are physiologically stressful, invasive interventions which may exacerbate or uncover underlying disease processes Some of the most feared complications include catastophic events such as myocardial infarction,difficulty oxygenating or ventilating, and cerebral vascular accident, among others A proper pre-operative assessment allows the perioperative providers (anesthesiologist and surgeon) the ability to stratify and reduce risk for the patient PowerPoint Presentation: General considerations When assessing patients for dental procedures who have elevated blood pressure, a number of questions must be answered. 1. Is the patient known to be hypertensive on a previous occasion? 2. Are they on antihypertensive medication? 3. Does the patient have a treatable cause for their hypertension? 4. Does the patient have “white coat” hypertension? 5. Does the blood pressure control need alteration before surgery? PowerPoint Presentation: Case PowerPoint Presentation: Algorithm for the approach to a patient with previously undiagnosed hypertension, presenting for anaesthesia and surgery. PowerPoint Presentation: Science is wonderfully equipped to answer the question ‘How?’ but it gets terribly confused when you ask the question ‘Why?’. Erwin Chargraff PowerPoint Presentation:   Where there is a will, there is a way. Where there is no way we will find one and build one. PowerPoint Presentation: http://www.vdraolectures.blogspot.com/

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