Table 2 - uploaded by Charles P Mouton
Content may be subject to copyright.
Risk factors for primary hypertension according to the JNC6 17 

Risk factors for primary hypertension according to the JNC6 17 

Source publication
Article
Full-text available
Janet H Southerland,1 Danielle G Gill,1 Pandu R Gangula,2–4 Leslie R Halpern,1 Cesar Y Cardona,5 Charles P Mouton6 1Department of Oral and Maxillofacial Surgery, 2Department of Oral Biology and Research, 3Department of Physiology, 4Center for Women's Health Research, 5Department of Internal Medicine, 6Department of Family and Community Medicine, Me...

Context in source publication

Context 1
... For those patients who are normotensive or with prehyper- tension, providing thorough education is key to prevention. Explaining risk factors (Table 2) associated with the disease and providing advice on lifestyle modifications, such as weight loss, diet modifications (dietary approaches to stop hypertension or DASH), decreased sodium intake, increased physical activity, and restricted alcohol intake could prove to be life saving in this population. 11,12,14 ...

Citations

... El manejo del estrés, las citas matutinas de corta duración, los cambios lentos de posición y el establecimiento de anestesia local profunda pueden prevenir cambios extremos en la hemodinámica general. 6 Los anestésicos dentales se definen como fármacos que bloquean la generación y propagación de impulsos en tejidos excitables, desde médula ósea, raíces nerviosas, nervios periféricos u otros tejidos excitables como músculo cardíaco, músculo liso y cerebro. 7 La mayoría de las complicaciones sistémicas durante los tratamientos dentales son causadas por el empleo del anestésico local, siendo las alteraciones cardiovasculares las que se presentan con mayor frecuencia. ...
Article
Full-text available
El paciente hipertenso acude con gran frecuencia a la consulta dental y resulta de suma importancia elegir un plan de tratamiento adecuado acorde a sus necesidades donde se incluya la correcta elección de anestésicos locales, así como un buen seguimiento. El objetivo de esta investigación es conocer si existe una relación entre la elección del anestésico y la tensión arterial al momento del tratamiento dental por los alumnos de una escuela de odontología en Nayarit. Se realizó un concentrado de datos de los 40 pacientes hipertensos que acudieron a la clínica de exodoncia de dicha escuela durante el semestre enero- julio del 2019. Los resultados son concluyentes en cuanto a que no hay una relación entre la elección del anestésico y las cifras de TA al momento del tratamiento dental, así como la necesidad de establecer parámetros para el manejo del paciente hipertenso.
... Cuando no existe una justificación o factores causantes identificables para esos valores elevados de TA, hablamos de HTA esencial o primaria 8 . Esta representa entorno al 90-95% de todos los casos. ...
Article
Full-text available
La ansiedad dental puede considerarse un fenómeno universal con una alta prevalencia a nivel mundial. Esta ansiedad y el dolor dental son las principales causas de urgencias médicas en la consulta odontológica, por lo que su prevención supone una parte esencial para la seguridad del paciente y la calidad general de la atención que este recibe. El objetivo principal del estudio es valorar los niveles de ansiedad y la evolución de los valores de tensión arterial (TA) y frecuencia cardiaca (FC) de un grupo de pacientes durante la primera visita odontológica y las revisiones rutinarias. Además, se describe y compara la evolución de la TA y la FC en pacientes normo e hipertensos controlados, y el posible efecto del sexo y edad del paciente sobre estos parámetros. Se llevó a cabo un estudio observacional analítico prospectivo sobre pacientes que acudieron para realizar primeras visitas y revisiones a la Clínica Universitaria de la Universidad Europea de Madrid entre octubre 2020 y febrero 2021. Los pacientes que cumplieron los criterios de inclusión rellenaron el Test de Corah y fueron sometidos a 4 mediciones diferentes de TA y FC. Se realizaron a cabo 48 primeras visitas; el 35,42% eran hombres y el 64,58% mujeres, con una edad de 44,79 ± 16,49 años. La puntuación del test de Corah tiende a ser superior en los pacientes hipertensos en pacientes de primera visita, y la edad es significativamente mayor en hipertensos. En el conjunto de pacientes de primeras visitas, la TAS y el pulso variaron a lo largo del procedimiento, siendo inferiores al final. No se observó esta diferencia en cuanto a la TAD. Se analizaron 32 revisiones, 17 fueron hombres (53,13%) y 15 mujeres (46,88%), con una edad media de 46,78 años (DE±16,91 años). La puntuación del test de Corah fue similar en los pacientes hipertensos y normotensos, no encontrándose diferencias estadísticamente significativas. En el conjunto de pacientes sometidos a revisiones sólo se observó diferencia en la evolución del pulso, pero no en la TA. La alteración de los niveles de TA y FC en pacientes hipertensos controlados es relevante a nivel clínico en primeras visitas y no en revisiones. El nivel de ansiedad es superior cuando el paciente no conoce al clínico.
... These surgeries present psychological and physiological stress to patients, which, in many cases, we are able to control so that patients display normal clinical conditions before and during surgical implant treatment [5,6]. However, mental stress, such as sadness, anger, uneasiness or fear, and nervousness, can cause an elevation in blood pressure (i.e., hypertension), which can result in cancellation of implant surgeries [7,8]. Sometimes, surgeries are cancelled because of hypertension right before the start of the procedure, despite presurgical measurements being normal and no prior history of medical conditions. ...
Article
Full-text available
Background Salivary alpha-amylase (sAA) activity level is thought to be an indicator of mental stress. However, the relationship between sAA activity levels and mental stress in patients during dental implant treatment has not been studied. In the present study, we aimed to examine the correlation between sAA activity levels and changes in patients’ vital signs during dental implant surgery. Results Levels of sAA activity were higher after surgery when compared to before-surgery measurements. A significant positive correlation was found between sAA activity and heart rate (HR) ( r s =0.434, p =0.007) as well as a positive correlation with oxygen level ( r s =0.392, p =0.016) . Conclusion Levels of sAA activity tended to increase after the surgical procedures, as did patients’ stress levels. SpO 2 and sAA activity levels were inversely correlated. There was a positive significant correlation between HR and sAA activity, though there was no correlation between blood pressure and sAA activity levels. Salivary alpha-amylase may be a valuable indicator of stress and anxiety in dental patients undergoing dental implant surgery .
... In addition, interactions may occur between drugs used to control hypertension and vasoconstrictors, causing hypertensive crises or orthostatic hypotension. 22 Dental pain is considered a public health problem and one of the main reasons that lead patients to seek dental care. 23 In urgent care, the correct access to pulp and the use of intracanal medication are fundamental steps for the management of endodontic pain. ...
Article
Full-text available
This study aimed to describe the structure of oral health services in primary health care in Brazil with centers participating in the second cycle of the 'National Program for Improving Access and Quality of Primary Care' (PMAQ-AB), the largest health service evaluation program ever instituted in the country. This cross-sectional study evaluated 16,202 oral health services, regarding 22 pieces of dental equipment and 25 dental supplies. The presence of each piece of equipment/dental supply generated a score for services. The sum of these scores was compared among different regions in Brazil. Quantitative data were described by quartiles and categorical data by frequencies, using the SPSS, version 25. Most of the evaluated centers presented adequate equipment in good using conditions and sufficient dental supplies for primary oral health care. Data also showed a lack of some equipment, such as X-rays, bicarbonate jet, and ultrasound devices, while for dental supplies, a lack of amalgam (capsule and manual preparation), anesthesia without vasoconstrictors, and intracanal medication was found. The services presented a median of 14 pieces of equipment and 22 dental supplies. Of the Brazilian regions, the South presented the highest median, while the North and Northeast regions presented the lowest one. The oral health services presented dental offices with good availability of equipment and dental supplies to perform clinical activities. However, differences in the structure of services among the Brazilian regions was still observed.
... Physiologic effects of adrenaline in varying concentration [11]: ...
... • 1:80,000 significantly increase in systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate; • 1:100,000 concentrations can increase SBP and heart rate; and • 1:200,000 is limited to an increase in heart rate, but less significant Pain itself has a significant effect on SBP, DBP on heart rate and adrenaline, even in the concentration of 1:200,000 significantly increases the duration and depth of local anesthetic. Adrenalin has a beneficial effect in this concentration without negative cardiovascular implications [11]. ...
Chapter
Full-text available
Oral and Maxillofacial surgery, like any surgical specialty, has two vital requirements. First, having the right armamentarium, and, second, acquiring appropriate skills and knowledge of the patients’ disease process, including comorbidities. With the changing demographic in India, the profile of Indian patient has undergone a sea change in the last few decades. From acute conditions that had little impact on subsequent health of the patient, we have arrived at a scenario where a large proportion of patients present with chronic disorders like diabetes, ischemic heart diseases, etc. that affect many elective procedures we undertake and require optimization of the overall physical status of the patient before proceeding with any surgery. Trainee surgeons need to be aware and updated and should be able to recognize, treat, or appropriately refer patients to the requisite specialty in case of complex conditions beyond their remit or ability. In this chapter, readers will get a very brief overview of the different organ systems that play crucial role in homeostasis and how to modify the treatment when there’s an imbalance in either of these systems.
... няма ясна причина, която да води до повишаване на кръвното налягане. При вторичната хипертония увеличеното кръвно налягане се дължи на увреждане в дру- (6,7). Концентрацията на епинефрин в една карпула варира от 1:200 000 до 1:50 000, като най-често използваните форми са 1:200 000 и 1:100 000. ...
... A thorough medical history is important to assess the risk of life-threatening conditions associated with hypertension, such as hypertensive crisis. 21 Sound knowledge and clinical competence is paramount in preventing and handling medical emergency situations. Management of an elderly patient also requires considerations of other various factors that may limit his acceptance and cooperation during the delivery of care and the eventual outcome of treatment. ...
... 22 The side effects of his medications should also be taken into account, so that appropriate measures can be planned to minimize the oral health risks that may result from their use. 21 Given the implications that may arise from the patient's health status, it is therefore crucial that his treatment is performed by a qualified professional who has appropriate training in managing medically compromised patients in a comprehensive manner. ...
Article
Full-text available
In this report, we present the case of a 68-year-old male patient with a complaint of mastication and speech limitations one year after the prescription of a fixed bridge and the construction of "connected" crowns by a "street dentist." A thorough oral examination revealed a multilobulated swelling in the right buccal mucosa that extended to the buccal sulcus. The lesion, which was first noticed as a small, asymptomatic swelling by the patient one year prior, seemed to have undergone enlargement since the prostheses were prescribed. The lesion was completely removed via surgical excision under general anesthesia. Histopathological examination of the excisional mass revealed mature adipocytes and features consistent with conventional or classic lipoma. This case highlights the importance of receiving dental treatment from a qualified professional, whose responsibilities include performing a thorough examination of the oral cavity during treatment planning and delivery, review appointments, and regular dental visits. Such investigation is important to allow for early disease detection and control, especially for patients with complex treatment needs as well as those who may present with asymptomatic and slow-growing lesions such as lipomas.
... 11 Risks for hypertension associated with epinephrine include increased acute hypertensive or hypotensive episodes, angina pectoris, arrhythmias, and myocardial infarction. 12 The perception of pain during administration of local anesthesia can contribute to the stress of the dental visit. Discomfort can be attributed to tissue puncture, fluid pressure, and the flow rate of the drug administered, 13 while other factors that may influence discomfort are fluid temperature and management of the needle upon full penetration of the tissue. ...
... 23 Thus, dental professionals must be on the frontlines of prevention of hypertension by evaluating preoperative blood pressure readings, performing risk assessments, and knowing when to refer a patient for medical consultation in a dental setting. 12 Studies of the prevalence of dental anxiety in the general population show a range of 2.6-20.4%, 24 and measurement of blood pressure during the stressful moments surrounding injection-giving helps dentists to avoid untoward cardiovascular events. ...
... Because hypertension affects~75 million United States residents, 32 as well as the fact that the administration of local anesthesia containing epinephrine can affect the cardiovascular system, gentle anesthesia management, and proper monitoring of patients receiving injections is crucial. 5 Patient variables that were not controlled in this study include the possibility that patients had variances in presurgical meal content, or other drugs which may have affected blood pressure responses, 12,25,33 possibly exacerbating or compounding the effects of the stress of the injection and the epinephrine contained within the anesthetic. ...
Article
Full-text available
To date, no study has evaluated blood pressure following administration of each carpule given for dental procedures using a computerized dental anesthesia system. Blood pressures taken prior to performing invasive periodontal procedures were compared with those readings measured following delivery of each of up to three consecutive carpules of Marcaine or Xylocaine in varying order. Pressure differences were also adjusted for age, sex, race, and whether a prescribed anxiolytic was taken beforehand. Neither systolic nor diastolic blood pressures changed significantly as compared to initial blood pressure readings. However, compared with Whites, Hispanics, and Middle Easterners, Blacks had significantly higher systolic pressure at the third carpule delivery, the cause being unknown. Blood pressure in patients being anesthetized for root planing and various periodontal surgical procedures will not increase significantly when administering up to three carpules, whether Marcaine or Xylocaine, in varying order, using controlled flow dental anesthesia, and this method may be preferable to syringes in managing dental procedural stress.
... Las cifras diagnósticas de hipertensión arterial son PAS ≥140 mm Hg y PAD ≥90 mm Hg (5). Empero, hay autores que definen la hipertensión como la elevación en por lo menos dos tomas o registros de TA con o sin provocación (2). ...
Article
Full-text available
Objetivo: evaluar la relación entre la condición de hipertensión arterial y las características sociodemográficas de los pacientes atendidos en la clínica de atención prioritaria de odontología de la Universidad del Valle, entre los años 2013 y 2016. Métodos: este es un estudio descriptivo retrospectivo de corte transversal. Las variables evaluadas fueron: edad, sexo, presión arterial diastólica y sistólica al inicio y al final de la consulta de valoración, grado de escolaridad, peso, talla, índice de masa corporal, conocimiento de condición de hipertensión, y prevalencia. Para analizar la información se empleó el programa Stata13. Como prueba de normalidad para las variables numéricas, se utilizó la prueba de Shapiro Wilks, para las variables que no se comportaron normal, la prueba U de Mann Whitney y para las variables categóricas con un error aceptado de p<0,05, la prueba de chi2. Resultados: se incluyeron 1815 pacientes en la muestra, de los cuales 528 tuvieron datos de tensión arterial ≥140/90 mm Hg. Así, el 70% desconocían que tenían valores ≥140/90 mm Hg. El 36% de las mujeres y el 23% de los hombres conocían su condición de hipertensión arterial. El índice de masa corporal por encima de 25.6, ser mayor de 50 años y el sexo femenino son factores de riesgo para la HTA. Conclusión: como factores de riesgo para la tensión arterial elevada se determinan el sexo, la edad y el índice de masa corporal. El 70% de los pacientes desconocían los valores de su tensión arterial y la prevalencia de probable hipertensión encontrada fue de 29%.
... Consequently, dentist surgeons are often responsible for the initial approach to hypertension by preoperative blood pressure measurement, risk assessment and medical referral. 8 Such perspective becomes a problem due to negligence on the part of some professionals, who disregard preoperative conditioning involving blood pressure measurement; studies have shown that 55% of professionals previously perform the measurement. 3 This lack of compliance is further complemented by the use of local anesthetics with sympathomimetic vasoconstrictors, considering that adrenaline acts predominantly in β receptors, causing increased heart rate and blood pressure, while justifying using the vasoconstrictor felypressinsynthetic vasopressin analoguefor emergency care in decompensated patients. ...
... Thus, the professional must have theoretical knowledge to ensure patient protection and avoid emergency situations. 8 The present study revealed that for controlled hypertensive patients, lidocaine 2% with adrenaline 1:100,000 again showed preference with 67.3%, followed by prilocaine 3% with felypressin 0.03IU. These results can be clarified by the statement that stress and pain can cause increased blood pressure, so it is conventional to use anesthetics with vasoconstrictors in the absence of contraindications, as besides providing deep anesthesia, they reduce systemic toxicity. ...
... These results can be clarified by the statement that stress and pain can cause increased blood pressure, so it is conventional to use anesthetics with vasoconstrictors in the absence of contraindications, as besides providing deep anesthesia, they reduce systemic toxicity. 8 Additionally, studies confirm that the use of epinephrine, respecting the maximum dosage of tubes, revealed a simple increase in blood pressure in controlled hypertensive patients; thus, choosing lidocaine with sympathomimetic vasoconstrictor is safe for controlled hypertensive patients. 15 Prilocaine appears as the second most used salt for its vasoconstrictor: ...
Article
Justificativa e Objetivos: O sucesso da técnica anestésica é fundamental para qualquer procedimento e garantia de segurança ao paciente, sendo sustentado por protocolos e fundamentos de caráter imperativo a fim de conferir o melhor atendimento. Nesse sentido, o presente trabalho verificará a utilização dos anestésicos locais, com ênfase em pacientes hipertensos, nos consultórios particulares da cidade de Palmas/TO. Métodos: Trata-se de um estudo descritivo, do tipo transversal de abordagem quantitativa realizado por meio de um questionário fechado de construção livre aplicado para profissionais do serviço privado de Palmas/TO, após assinatura do Termo de Consentimento Livre e Esclarecido. Foi realizada análise descritiva de 113 questionários por intermédio do Statistical Package for the Social Sciences 22.0. Resultados: Dos entrevistados, 58,4% eram mulheres, a especialidade mais encontrada foi implantodontia (20,4%); 53,1% apontaram que a escolha do anestésico é feita de acordo com a condição do paciente; 47,8% dos profissionais possuem mais de 3 tipos de anestésicos disponíveis para o atendimento; 53,1% apontou ensino de anestesiologia na graduação satisfatório; 65,5% não frequenta cursos e palestras sobre esse tema; 41,6% dos dentistas aferiam a pressão somente em hipertensos, lidocaína foi o sal mais utilizado de forma geral e também de forma especifica ao considerar somente hipertensos. Conclusão: O anestésico local mais utilizado em hipertensos é a lidocaína 2% com adrenalina 1:100.000, porém a maioria dos profissionais só afere a pressão arterial em já diagnosticados com hipertensão, expondo resultados relativamente satisfatórios em virtude de condutas que ainda necessitam ser readequadas.