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Are You Well Versed in the New Blood Pressure Guidelines?

Numerous studies have shown blood pressure levels are positively related to the risk for stroke and coronary heart disease.

Are You Well Versed in the New Blood Pressure Guidelines?

Numerous studies have shown blood pressure levels are positively related to the risk for stroke and coronary heart disease. According to Global Health Observatory data, raised blood pressure can lead to heart failure, peripheral vascular disease, renal impairment, retinal hemorrhage, and visual impairment. To allow for earlier intervention with lifestyle changes and nonpharmaceutical approaches, the American College of Cardiology and American Heart Association (ACC/AHA) released new guidelines to lower the definition of high blood pressure in 2017. The new ACC/AHA guidelines were developed with nine other professional organizations and were written by a panel of 21 scientists and health experts who reviewed more than 900 published studies.

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Taking Patients’ Blood Pressure

Over the years, screening for various diseases has become more prevalent in the dental setting. Numerous studies have validated the significance of chairside medical screening in the dental setting and the willingness of oral health professionals to conduct it. Patients are also open to medical screening in the dental setting. High blood pressure screening in dental settings is an effective way to detect unknown hypertension.

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Taking the Measurements Correctly

Blood pressure is measured in millimeters of mercury (mm Hg) using two numbers. The first number is called systolic blood pressure, which represents the pressure in the blood vessels when the heart beats while pumping blood. The second number is called diastolic blood pressure, which indicates the pressure in the blood vessels when the heart is at rest between beats. The gold standard for blood pressure measurement is the auscultatory method (sphygmomanometer and stethoscope), with digital arm and automated equipment as secondary modalities. Digital or electronic automatic blood pressure equipment is used in dental education institutions and commonly used in dental practices for convenience and low cost; however, clinical accuracy may be compromised. As such, if the reading is questionable, the blood pressure should be taken again using the auscultatory method or the patient should be referred to his or her primary care provider.

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New Guidelines

The new guidelines lower the definition of high blood pressure to 130/80 mm Hg for adults. This new definition broadens what defines disease, encompassing people who were previously considered healthy. Approximately 46% of US adults now have hypertension compared with about 32% under the former high blood pressure definition. Normal blood pressure is now considered below 120/80 mm Hg and elevated blood pressure is 120 mm Hg to 129 mm Hg systolic with a diastolic pressure below 80 mm Hg. Stage 1 hypertension is between 130 mm Hg and 139 mm Hg, or 89 mm Hg and 89 mm Hg (formerly known as “prehypertension”) and stage 2 hypertension is 140/90 mm Hg or higher (the old definition of high blood pressure).

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Role of Oral Health Professionals

Oral health professionals need to become familiar with the new guidelines so they can educate patients about the impact on their overall health. Each blood pressure category has management recommendations and can be easily printed as an education/information handout. Patient education regarding both the adult and child/adolescent guidelines is important and oral health professionals should be prepared to provide referrals for further evaluation, if applicable. For patients whose blood pressure is deemed too high, medical clearance should be obtained before administering dental treatment to avoid an emergency situation.

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