Dent Clin N Am 50 (2006) 547–562

Dental Management of Patients with Hypertension
J. Bruce Bavitz, DMD, FACD
Department of Surgical Specialties, University of Nebraska Medical Center, College ofDentistry, 40th and Holdrege, Lincoln, NE 68583-0757, USA

Surprisingly, there is little if any data to indicate that treating a patient with hypertension alone increases the risk for adverseoutcomes or complications. Most dentists, however, realize that hypertension often leads to cardiovascular disease, renal disease, and strokes, which are conditions that increase the risk for complications,both during and after dental care. Oral and systemic side effects may also arise from the medicines used to treat hypertensive patients. This article reviews the current thought on the pathogenesis,diagnosis, and treatment of hypertension, and provides guidance on how best to treat patients with this common medical problem.

Physiology Blood pressure (BP) is determined by how much blood theheart pumps (ie, cardiac output) and by the resistance to blood flow in the vascular system. Cardiac output in turn is determined by how often the pump contracts (ie, heart rate) and by the amount ofblood ejected during each beat (ie, stroke volume). High blood pressure, therefore, results from either narrow inflexible arteries, an elevated heart rate, increased blood volume, more forcefulcontractions, or any combination of the above. BP is never constant; it peaks right after the ventricles contract (systole) and reaches its low point as the ventricles fill (diastole). Mean arterial pressure(MAP) is calculated by multiplying the diastolic BP by two, adding the systolic BP, and dividing by three. Diastolic BP is multiplied by two as, on average, the heart spends roughly twice the amount oftime in diastole as in systole. The long-term regulation of BP is controlled predominantly by the kidneys through their variable release of the enzyme renin. Renin goes on to

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