High Blood Pressure: What are the Risks for Our Teeth?

Arterialhypertension, or AH, is the most common chronic disease in France. It is estimated that about 1 out of 3 French people would be affected by it and half of them are not even aware of it since it is a disease that evolves quietly. If left untreated, hypertension can lead to life-threatening complications, including myocardial infarction(MI) andstroke.

Moreover, this cardiovascular pathology is closely linked to our dental health! Nutrident.fr has therefore studied the subject and tells you everything you need to know about the one nicknamed ” the silent killer “.

What is high blood pressure?

Bloodpressure ” or ” blood pressure ” is the force that blood exerts on the walls of the blood vessels. When it permanently exceeds a certain level, it is called hypertension.

In a normal adult, systolic blood pressure or ” SBP ” (when the heart contracts) is less than 140 mmHg (millimeter of mercury, a unit of measurement for pressure) and diastolic blood pressure or ” DBP ” (when the heart relaxes) is less than 90 mmHg

In a hypertensive subject:

• Systolic hypertension is defined as PAS greater than 140 mmHg while DBP remains normal (<90 mmHg) on repeated measurements;
• Diastolic hypertension occurs when DBP is greater than 90 mmHg while SBP remains normal (<140 mmHg) on repeated measurements,
• And when there is an elevation of both SBP and DBP on repeated measurements, it is called mixed hypertension (SBP > 140 mmHg and DBP > 90 mmHg).

What are the symptoms of high blood pressure?

In the vast majority of cases, hypertension is not manifested by any clinical signs. It is then diagnosed during a routine medical consultation or for another pathology( incidentaldiscovery ).

However, there are certain signs that can alert you to the possibility of a problem. These are the same symptoms that your doctor will look for when he or she questions and examines you. Here are the most frequently observed:

• Headaches located in the neck, back of the head or at the sleep of the head;
• Dizziness and dizziness;
• Visual disturbances such as visual fog, impression of flying flies ;
• Ringing in the ears;
• Tingling sensation in the extremities(numbness in fingers, hands, toes, feet);
• Permanent fatigue and confusion;
• Epistaxis (bleeding out of the nose);
• Hemorrhages in the conjunctiva;
• A tendency to have muscle cramps;
• Frequent urination;
• Shortness of breath: this is a sign of left ventricular failure, it follows chronic high blood pressure.

How is high blood pressure diagnosed?

When you are at the doctor's and he finds an elevated blood pressure, he will take several measurements under various conditions: at rest and after an effort, lying down, sitting down, standing up, each time measuring the blood pressure on the left and right arm.

In the case of labile hypertension , that is to say that there is an alternation between normal blood pressure and hypertension during the day, the doctor can use ABPM (Ambulatory Blood Pressure Measurement). This examination, which is a kind of blood pressure monitor that inflates automatically at regular intervals (usually every 15 minutes during the day and every 30 minutes at night) connected to an electronic box that records the blood pressure figures. After processing these with special software, the diagnosis of hypertension is either retained or eliminated. Management then depends on the results of this simple and effective examination.

Nowadays, everyone has access to a blood pressure monitor and can monitor their own blood pressure and that of their family members or friends. This allows for early detection of this disease so that it can be properly managed and its formidable complications prevented. Moreover, self-measurement is more reliable than a measurement at the doctor's office because it eliminates the ” white coat effect ” (anxiety in front of the doctor increases blood pressure and can give a false idea about it).

What are the risk factors for hypertension?

High blood pressure can be promoted by the following factors:

• A high salt diet;
• Sedentary lifestyle;
• Stress;
• Overweight;
• Alcohol and tobacco use;
• The abuse of black licorice ;
• The contraceptive pill;
• Repeated emotional shocks;
• Treatment with certain drugs: long-term corticosteroids, anti-VEGF, erythropoietin…

These risk factors are all modifiable, meaning that they can be removed to prevent the development of hypertension .

High blood pressure can also be observed during pregnancy, this is called ” gestational hypertension “.

What can cause hypertension?

In the vast majority of cases, hypertension is said to be idiopathic or ” essential “. In other words, no cause is found. The treatment is then purely symptomatic, i.e. anti-hypertensive drugs are given to lower the blood pressure.

In some cases, high blood pressure is secondary to a condition that, once treated, will cause the high blood pressure to disappear. Here are some of its pathologies:

HTA of renal origin

There are many kidney diseases that cause hypertension, as the kidneys play an important role in the regulation of blood pressure:

• Glomerulonephritis;
• Diabetic glomerulopathy;
• Gout (metabolic disease characterized by an accumulation of uric acid in the blood);
• Polycystic kidney disease (development of cysts in the kidneys);
• Chronic secondary pyelonephritis a chronic or repeated urinary tract infection;
• Renal artery stenosis;
• Renal tuberculosis.

Adrenal hypertension

We can quote as an example:

• Cushing ‘s syndrome (excess cortisol in the blood);
• Conn's syndrome (aldosterone excess);
• Adrenaline-secreting tumor (pheochromocytoma).

Can high blood pressure be dental in origin?

An American study carried out on a cohort of postmenopausal women showed a 20% increase in the risk of hypertension in those who had lost one or more teeth .

At first glance, teeth have no connection with blood pressure regulation. So how do we explain these results? Scientists have hypothesized that tooth loss leads to changes in diet. Indeed, people who lose their teeth have more and more difficulty chewing. This leads them to consume processed foods, which are easier to chew but loaded with salt, which is one of the major modifiable risk factors for hypertension.

Dental hygiene and close monitoring of people at risk of tooth loss are therefore very important means of preventing hypertension.

What are the complications of hypertension?

High blood pressure must absolutely be treated even if there are no symptoms, because in the long term it represents a danger to several organs:

The heart

When there is high blood pressure in the blood vessels, the heart has to work harder to pump blood. These cells, called cardiomyocytes, will then hypertrophy (increase in volume) to be more powerful. But over time, these cells die and this causes heart failure. That is, the heart is no longer strong enough to perform its function properly.

The brain

Changes in the walls of the brain vessels can lead to arterial blockages or rupture . High blood pressure can therefore cause a hemorrhagic or ischemic stroke in the long term.

The kidneys

Chronic hypertension progressively alters the walls of the renal arteries. These harden and lose their elasticity. This will eventually lead to renal failure.

Blood vessels

Vessels that are under permanent stress undergo progressive remodeling. They become less elastic and more rigid, this is called arteriosclerosis. The latter will then be at the origin of many serious pathologies, notablyobliterating arterial disease of the lower limbs (AOMI), stroke and myocardial infarction (MI).

The eyes

The alteration of the retinal vessels damages the retina, this is called hypertensive retinopathy. The latter can lead to blindness (loss of sight).

How is hypertension treated?

The treatment of high blood pressure is based on two main pillars: hygiene and dietary rules and medication.

Hygienic and dietary rules

They are always indicated, regardless of the degree of hypertension. They are even the only treatment prescribed for mild or minimal hypertension.

These are the same rules that are recommended for the prevention of hypertension, which means that everyone should apply them to avoid the occurrence of this extremely frequent condition with serious complications. They are even more important in people at risk for hypertension, especially those with a family history of early-onset hypertension

Here are some of the rules:

• Decrease your salt consumption: salt is hidden in many foods, so you must track it down daily by checking the labels of the different products you eat.
• Eat 5 fruits and vegetables a day, as recommended by the WHO.
• Limit alcohol and caffeine consumption;
• Quitting smoking;
• Fill up on omega 3: by eating cod liver oil, mackerel, salmon, herring…
• Regularly consume garlic, which is known for its blood pressure regulating properties;
• Engage in regular moderate physical activity such as walking, swimming, gardening…
• Losing weight
  weight
  is achieved through a balanced diet and physical exercise;
• Get away from stress as much as possible or manage it through various relaxation methods (abdominal breathing, meditation, sessions with a psychologist…).
• To have an irreproachable oral hygiene to avoid periodontal diseases and dental falls (recognized as a factor supporting the development of the HTA).

Drug treatments

In some cases, dietary hygiene measures alone are not sufficient to achieve satisfactory blood pressure levels. It is therefore necessary to use anti-hypertensive drugs. The improvement of the hygiene of life remains nevertheless indicated because it allows to reduce the dosage of the prescribed treatments. A global approach is always required when managing this pathology.

Here are the most common medications used to treat hypertension:

• Diuretics: they act on the kidneys by promoting the elimination of water and salt through the urine.
• Calcium channel blockers: they act on the blood vessels by causing them to dilate (vasodilators).
• Beta-blockers: they act on the heart by lowering the heart rate and decreasing the strength of heart contractions.
• ACE inhib itors (ACE inhibitors): cause vasodilatation.
• Sartans or angiotensin receptor blockers (ARBs): they prevent the arteries from contracting.

In most cases, the physician prescribes an initial treatment and then reviews the patient after a period of time to adjust the dosage or change the medication after evaluating the effectiveness of the treatment. Combinations of drugs can be used to treat hypertension that does not respond to monotherapy.

The goal is to achieve satisfactory blood pressure levels using the lowest possible dose of medication. This is called the ” minimum effective dose “. This is to minimize the adverse effects of the various medications.

Sources:

“Poorer oral health linked to higher blood pressure,” published Oct 22, 2018, at sciencedaily.com

“Risks of high blood pressure” section published in the article on the subject on NHS.UK

“Gum disease and tooth loss linked to high blood pressure” published on dentalhealth.org on 11 Dec 2018