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Hypertension

Globally, an estimated 26% of the world’s population (972 million people) has hypertension, and the prevalence is expected to increase to 29% by 2025, driven largely by increases in economically developing nations. Regarded as a primary contributor to heart disease and stroke, the first and third leading causes of death worldwide, respectively.

Arterial Hypertension as a risk factor

Hypertension is a highly prevalent risk factor for cardiovascular disease Hypertension plays a major etiologic role in the development of cerebrovascular disease, ischemic heart disease, cardiac and renal failure

Laboratory and instrumental investigation- routine tests

Serum total cholesterol, LDL, HDL Fasting serum triglycerides Fasting plasma glucose Serum potassium Serum uric acid Serum creatinine Haemoglobin and haematocrit Urinalysis Electrocardiogram Echocardiogram

Secondary causes of AH

Renal parenchymal disease (most common cause)Renovascular hypertension (2nd most common cause)Pheochromocytoma Primary hyperaldosteronismCushing’s syndromeObstructive sleep apneaCoarctation of aortaDrug-induced hypertension

Benefits of Lowering BP

Average reductionStroke incidence 35–40% Myocardial infarction 20–25% Heart failure>50%

Aim of antihypertensive therapy

The primary goal of treatment is to achieve (< 140/90 mm Hg) and treatment of all reversible risk factors are indicated In diabetes and in high risk patients BP target should be at least < 130/80 mmHg


Lifestyle changes
smoking cessation weight reduction reduction of alcohol intake physical exercise reduction of salt intake increase in fruit and vegetables intake decrease in saturated and total fat intake

Antihypertensive drugs

thiazide diuretics calcium antagonists (CA) ACE-inhibitors (ACEI) angiotensin receptor blockers (ARB) beta-blockers (BB)

Dental Aspect

SBP< 140,DBP < 90 (I) Routine dental careSBP=140–159,DBP=90–99 (II) Recheck BP before starting routine dental careSBP=160–179,DBP=99–109 (III) Recheck BP and seek medical advice before routine dental care Restrict use of adrenaline/ epinephrine Conscious sedation may help

SBP> 180,DBP > 110 (IV) Recheck BP after 5 min quiet rest. Medical advice before dental care Only emergency care until BP controlled Avoid vasoconstrictors


An aspirating syringe should be used to give a LA, since epinephrine (adrenaline) in the anaesthetic given intravenously may (theoretically) increase hypertension and precipitate arrhythmias


Corticosteroids may raise the blood pressure and antihypertensive treatment may have to be adjusted accordingly. Some NSAIDs (indometacin, ibuprofen and naproxen) can reduce the efficacy of antihypertensive agents.


Antihypertensive drugs can sometimes cause orofacial side-effects, such as xerostomia, salivary gland swelling or pain, lichenoid reactions, erythema multiforme, angioedema, gingival swelling, sore mouth or paraesthesiae

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