Hypertension: On the Pill? Tell your dentist

December 10, 2004

Hypertension, a controllable and preventable disease (and more commonly known as high blood pressure), affects 1 in 4 American adults. Causes are unknown in 90 percent of all cases. However, the most common cause of secondary hypertension in women is oral contraceptive use, according to a report in the November/December issue of General Dentistry, the Academy of General Dentistry's (AGD) clinical, peer-reviewed journal.

Up to five percent of women taking birth control pills that contain a high dose of estrogen (above 35 micrograms of ethinyl estradiol) may experience oral contraceptive-related high blood pressure, says Mary A. Aubertin, DMD, author of the report, who cites studies reported by the Association of Reproductive Health Professionals (ARHP) and in the journal, Circulation. High blood pressure may lead to heart disease and stroke. Discontinuing the use of birth control pills or switching to a lower estrogen dose can reduce blood pressure.

"These findings are important for women and will help dentists better understand how patients, including those on birth control pills, may be at risk to develop hypertension," says Dr. Aubertin.

Typically, hypertension produces no symptoms until blood pressures become extremely elevated. Symptoms of very high blood pressure include headaches, dizziness, confusion and tingling of the hands and feet. In addition to the use of birth control pills, dentists are learning that race, stress, obesity, smoking, heavy drinking, genetics, age and inactivity may be risk factors to develop the disease.

According to the American Heart Association (AHA), as many as 50 million Americans age sixty and above have hypertension. Of those people, 30 percent do not know they have it and 41 percent do not receive therapy. Only 34 percent have their blood pressure under control.

Last year, the National Heart, Lung and Blood Institute (NHLBI) recommended new guidelines to help professionals and public determine those at risk of high blood pressure. A new category called "prehypertension" explains that the risk for cardiovascular disease now is believed to begin when blood pressure is 115/75 millimeters of mercury (mm/Hg) instead of at 140/90.

"Monitoring blood pressure at the dental office helps dentists become part of a patient's health care team," says Dr. Aubertin. "Dentists want to educate the public to pay attention to and manage their blood pressure before complications occur."

Studies show that damage to arteries--and the risk for heart attack and stroke--actually begin to rise at 115/75. Medical experts issued new blood pressure guidelines:

If systolic (top) pressure is less than 120 and if diastolic (bottom) pressure is less than 80, you are normal. If systolic pressure is 120-139 or if diastolic pressure is 80-89, you are experiencing prehypertension. If systolic pressure is 140-159 or if diastolic pressure is 90-99 you are experiencing stage 1 hypertension. If systolic pressure is 160 or higher or if diastolic pressure is 100 or higher, you are in stage 2 hypertension.

Hypertensive patients have a few things they should be aware of at the dental office:
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The AGD is a non-profit organization of more than 37,000 general dentists dedicated to staying up-to-date in the profession through continuing education. A general dentist is the primary care provider for patients of all ages and is responsible for the diagnosis, treatment, management and overall coordination of services related to patient's oral health.

Academy of General Dentistry

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