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NEW HYPERTENISON GUIDELINES

New guidelines for the evaluation and management of hypertenison new are available from the National Heart, Lung and Blood Institute. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure, or JNC 7, substantially revises previous recommendations.
Hypertention is the most common primary diagnosis in the United States affecting 50 million Americans. The condition's prevelance is likely to increase with the demographic shift to an older population. Data from the famous Framingham Heart Study indicate that people who have normal blood pressure at 50 years of age have a 90% lifetime risk of developing hypertension.
To appropriately manage a patient's dental care, dentists must be knowledgable about hypertension, its detection and treatment. The care of a patient with undetected or poorly controlled hypertension requires consultation with the patient's physician. Also, a significant number of anti-hypertensive medications have undesirable oral side effects that require assessment and potential intervention by the dentist.
For people older than 50 years of age, systolic blood pressure (SBP) greater than 140 millimeters of mercury is considered a much more important risk factor for cardiovascular disease (CVD) than is elevated diastolic blood pressure (DBP). (Keep in mind that SBP is the top number and DBP the bottom number in the readings). This focus on SBP is a substantial change from recommendations as recently as 15 years ago when hypertension was defined solely as DBP of 90 or higher.
JNC 7 introduces a category called "prehypertensive" to describe people with SBP of 120 to 139 or a DBP of 80 to 89. This term replaces and expands the previously used terminology of "high normal" (130-139/85-89). The risk of a stroke or heart attack doubles for each increase in BP,in 20/10 millimeters of mercury increments, starting at 115/75. The JNV 7 report reduces the number of categories of hypertension to only two; Stage 1 hypertension is defined as SBP of 140 to 159 or DBP of 90 to 99 and stage 2 hypertension of SBP of 160 or over or DBP of 100 or higher.
Effective antihypertensive therapy reduces the incidence of stroke by 35 to 40 percent, myocardial infarction (heart attack) by 20 to 25 percent and heart failure by more than 50 percent. This therapy may be as simple (albeit not easy) as lifestyle changes but diuretics and/or medications are required for most hypertensive patients (the majority of patients require more than one medication to control the disease).
Over 30 percent of hypertensive patients are unaware that they have the condition and only 59 percent are being treated but only 34 percent of these have their blood pressure controlled consistant with JVC 7 guidelines. This makes it obvious that practicing dentists encounter patients with undetected or poorly controlled hypertension. Elevated blood pressure increases a patient's risk of experiencing heart problems such as chest pains, heart attacks or strokes while undergoing dental care. Elevation of SBP higher than 180 or DBP higher than 110 is considered to be the cutoff point for offering dental care without consultation and referral.
Some of the complications of hypertensive treatment medications are hypotention (fainting or dizziness), xerostomia, or dry mouth, which increases the potential for cavity formation, overgrowth of gum tissue, yeast infections in the oral cavity, dry cough and potential adverse interaction with other medications.
We routinely take blood pressures in our office and we have been known to dismiss patients with uncontrolled stage 2 hypertension without treatment - for their own safety! Also, it has become very apparant that many patients on blood pressure medications need additional therapy. Hypertension is, indeed, the silent killer so please don't ignore our findings if they are not within the normal ranges.

posted by Steve at 2:18 PM