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approximately 2.5% of adults in the United States have valvular Monitoring vital signs routinely would also enable dental pro-
disease, and valvular heart disease is more prominent in the elder- fessionals to keep records of baseline vital signs. Documenting
ly population. Treatments of valvular heart disease involve heart baseline vital signs would provide dentists an objective measure
17
valve replacement or repair surgery. 18 to monitor overall health of each patient and ultimately promote
patient-centered care. Baseline vital signs would serve as a standard
Other systemic complications related to hypertension that dentists could refer to in the case of a medical emergency.
About 85 to 95% of patients with chronic kidney disease (CKD) Antihypertensive medications
are reported to have hypertension. CKD and hypertension have
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a bidirectional relationship: hypertension is both a common cause Beta-blockers, diuretics, angiotensin-converting enzyme inhib-
and result of CKD. Hypertension can lead to CKD by causing in- itors (ACE-Is), angiotensin II receptor blockers (ARBs), calcium
jury to the kidneys and eventually leading to glomerulosclerosis, channel blockers (CCBs), and alpha blockers are the most com-
which is scarring of glomerulus in the kidneys. CKD resulting from monly used antihypertensive regimens. Since these medications
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hypertension would further exacerbate hypertension since damage are frequently encountered , dental professionals should familiar-
in the kidneys and decreased glomerular filtration rate (GFR) would ize themselves with side effects and drug-drug interactions of these
impair excretion of sodium and ultimately damage pathways that regimens (Table 2). 24,26
regulate blood pressure such as renin angiotensin aldosterone sys-
tem (RAAS). Thus, it is important to control the blood pressure Drug Systemic side Dental side Drug
of patients with CKD. Failure to maintain the optimal blood pres- effects effects interactions
sure can lead to accelerated progression to end-stage renal disease
(ESRD) which would require a renal transplant or renal replace- Beta- Orthostatic Dry mouth, NSAIDs,
ment therapy. According to the ACC/AHA guidelines published blockers hypotension, dysgeusia, epineph-
20
in 2017, the recommended optimal target blood pressure in patients blood dyscrasia lichenoid rine (only
with CKD and hypertension is lower than 130/80mmHg. Treat- reaction non-selective
21
ment of CKD often involves antihypertensive medications such as beta-blockers),
angiotensin-converting enzyme inhibitors (ACE-Is) and angioten- local anesthetics
sin II receptor blockers (ARBs). 22 Diuretics Orthostatic Dry mouth, NSAIDs,
Another commonly seen systemic complication related to hyperten- hypotension, lichenoid barbiturates,
sion is stroke. Stroke is a condition in which focal blockage of ce- blood dyscrasia reaction fluconazole
rebral, spinal, or retinal blood supply or cerebral hemorrhage caus- ACE Orthostatic Dry mouth, NSAIDs
es neurological dysfunction. Hypertension significantly increases inhibitors hypotension, ageusia,
the risk of stroke since it would increase the risk of infarction and dry cough, burning
hemorrhage. Thus, it is imperative that clinicians control hyperten- neutropenia, mouth,
sion. About 30% of stroke recurrence was successfully prevented delayed healing, ulceration,
through managing hypertension via antihypertensive regimens. gingival bleeding angioedema
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Management of patients with hypertension and complications ARBs Orthostatic Dry mouth, Systemic
from hypertensive heart diseases hypotension, angioedema, antifungal,
cough sinusitis, sedatives
Routine monitoring of vital signs ageusia
CCBs Orthostatic Gingival NSAIDs,
Monitoring patient’s vital signs and evaluating for hypertension can hypotension, enlargement, aspirin, ben-
enable dental professionals to enhance the comprehensive care of erythema dry mouth, zodiazepines,
their patients. Despite the high prevalence of hypertension and the multiforme dysgeusia parenteral an-
complications of hypertensive heart disease, there is still a stagger- esthetic agents,
ing number of patients with undiagnosed hypertension: about 30% erythromycin,
of patients have undiagnosed hypertension in the United States. clarithromycin
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Since most hypertension and complications of hypertensive heart
disease are asymptomatic, many patients are unaware that they Alpha Orthostatic Dry mouth NSAIDs, CNS
have hypertension or complications of hypertensive heart disease blockers hypotension depressant,
until their conditions deteriorate. Thus, taking vital signs on a reg- salicylates
ular basis on patients enables dentists to operate as the frontline of
detection and prevention of the problem. Early detection of hyper- Direct- Orthostatic Increased NSAIDs,
tension would reduce the number of systemic complications related acting hypotension, risk of opioids
to hypertension and ultimately decrease morbidity and mortality vasodilators blood dyscrasia, gingival
rate related to hypertension. lymphadenopathy bleeding and
infection,
In addition to the high prevalence of undiagnosed hypertension, facial flushing
there is still a high number of uncontrolled hypertensive patients. Data from Refs. [24],[26].
About 44% of hypertensive patients are only getting minimal blood
pressure control, with readings less than 140/90mmHg, and only Table 2. Side effects and drug interactions of antihypertensive medications
24% of hypertensive patients are getting optimal blood pressure that are of interest to dental providers
control, with readings equal to or less than 130/80mmHg. Taking
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vital signs routinely in the dental clinic would serve as a reminder
for hypertensive patients to take medications regularly and reassure
them about the importance of controlling their high blood pressure.
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