Mrs. Nina was recently diagnosed with hypertension and high cholesterol. She has been prescribed lisinopril/hydrochlorothiazide to treat her hypertension and atorvastatin to treat her cholesterol. Lisinopril is an ACE inhibitor used to treat hypertension. It works by relaxing blood vessels to lower blood pressure. ACE inhibitors can cause dry mouth, a side effect that increases risk of cavities if not managed properly. The patient should be counseled about maintaining good oral hygiene and drinking water to prevent dry mouth from antihypertensive medications from increasing risk of cavities and gum disease. Regular dental checkups are important for monitoring oral health during drug therapy.

1. Drugs Affecting
Cardiovascular Diseases
Dental Pharmacology
By
Taha Hussein Kadi , MSc
Lecturer of Pharmacology & Toxicology
UST

2. What’s a Hypertension ?

3. Hypertension
• Hypertension is a common cardiovascular
disease affecting worldwide population.
• A persistent and sustained high blood pressure
has damaging effects on the heart, brain, kidneys
and eyes.
Could be:
1. Primary or essential hypertension: It is the most
common type. There is no specific underlying
cause.
2. Secondary hypertension: It can be due to renal,
vascular, endocrine disorders, etc.

4. Blood Pressure
• Systolic blood pressure (SBP): It is the maximum
pressure recorded during ventricular systole.
• Diastolic blood pressure (DBP): It is the
minimum pressure recorded during ventricular
diastole.
• Pulse pressure (PP): It is the difference between
systolic and diastolic blood pressure
(PP = SBP –DBP)
Hypertension

5. Hypertension

6. • Diuretics
– Thiazides and related agents: hydrochlorothiazide,
indapamide.
– Loop diuretics: Furosemide, bumetanide, torsemide.
– Potassium-sparing diuretics: spironolactone,
Amiloride, triamterene.
• ACE inhibitors: Captopril, enalapril, lisinopril, ramipril.
• Angiotensin II receptor antagonists: Losartan,
candesartan, valsartan.
• Calcium channel blockers:
– Non- Dihydropyridine : Diltiazem, verapamil.
– Dihydropyridine : nifedipine, amlodipine …etc.
Classification of Antihypertensive Drugs

7. • Sympatholytic agents
– Centrally acting adrenergic drugs: Clonidine, methyldopa.
– Adrenergic blockers: Atenolol, metoprolol, propranolol etc
– Adrenergic blockers with additional a-blocking activity:
Labetalol, carvedilol.
– α-Adrenergic blockers:
• Selective: Prazosin, terazosin, doxazosin.
• Nonselective: Phenoxybenzamine, phentolamine.
• Vasodilators
– Arteriolar: Hydralazine, minoxidil, Diazoxide
– Arteriolar and venodilator: Sodium nitroprusside
Classification of Antihypertensive Drugs

8. Diuretics

9. ACE inhibitors

10. Angiotensin II receptor antagonists

11. Calcium channel blockers

12. Vasodilators

13. Hydralazine

15. • It is characterized by a very high blood
pressure (systolic >220 and/or diastolic >120
mmHg) with progressive end-organ damage
such as renal dysfunction and/or hypertensive
encephalopathy.
• The BP should be reduced by not more than
25% within minutes to 2 h, and then to
160/100 mm of Hg within 2–6 h.
Hypertensive Crisis
(Hypertensive Emergencies)

16. • The preferred drug to treat the condition is
sodium nitroprusside (i.v. infusion).
• The other drugs :
– nitroglycerin (i.v. infusion)
– hydralazine (i.v.)
– labetalol (i.v.)
Hypertensive Crisis
(Hypertensive Emergencies)

19. Angina pectoris
https://www.youtube.com/watch?v=
afYCN3Upy_w

20. Angina pectoris
• Angina pectoris is a symptom of ischaemic heart
disease. It is due to an imbalance between oxygen
supply and oxygen demand of the myocardium.
Types of angina pectoris
• Stable angina (classical angina): It is characterized by
episodes of chest pain commonly associated with
exertion.
• Unstable angina: It is characterized by angina at rest or
increased frequency and duration of anginal attacks.
– due to rupture of an atheromatous plaque and platelet
deposition in the coronary artery, leading to progressive
thrombosis.
• Prinzmetal’s angina (variant angina): Angina that
occurs at rest and is due to spasm of coronary arteries.

21. Pathophysiology
Angina occurs due to imbalance in oxygen
supply and demand by the myocardium.

22. Treatment Strategies

23. 1. Nitrates: Nitroglycerin , isosorbide dinitrate,
isosorbide mononitrate, Amyl nitrite (Inhalation)
2. β-Adrenergic blockers: Propranolol, metoprolol,
atenolol.
3. Calcium channel blockers (CCBs): Verapamil,
diltiazem, nifedipine, amlodipine.
4. Others:
– Antiplatelet agents(low-dose aspirin,clopidogrel)
– Statins “Atorvastatin” ( antihyperlipidemia)
Classification

24. Nitrates
• For an acute attack, nitroglycerin is commonly administered
sublingually with an initial dose of 0.5 mg, which usually relieves
pain in 2–3 min.
• Patient is advised to spit out the tablet as soon as the pain is
relieved to avoid side effects (hypotension and headache).
• If the pain is not relieved, the tablet can be repeated after 5 min;
but not more than three tablets in 15 min.
• If pain is not relieved, it could be MI. Give tablet aspirin 325 mg
orally, oxygen by face mask, then refer the patient to cardiologist.

26. https://www.youtube.com/watch?v=
mhYeO2fwSps
CONGESTIVE
CARDIAC FAILURE

27. CONGESTIVE CARDIAC FAILURE
• The function of the heart is to pump an adequate
amount of blood to various tissues.
• In CCF, there is an inadequate contraction of the
heart leading to reduced cardiac output (CO).
• The compensatory mechanisms that try to
maintain the cardiac output are:
• Increased sympathetic activity.
• Increased renin–angiotensin–aldosterone activity.
• Myocardial hypertrophy.

28. • As time progresses, the compensatory
mechanisms fail and gradually clinical
symptoms of failure appear.
• The basic haemodynamic disturbances seen
in congestive cardiac failure are:
– Pulmonary edema which is characterized by
dyspnea.
– Decreased cardiac output leading to peripheral
edema, tissue hypoxia.
CONGESTIVE CARDIAC FAILURE

29. Increase
contractility

30. Case
• Nina is 56 years old and has been coming to your practice for close
to 15 years. Until recently, she would take only acetaminophen for
an occasional headache. Mrs. Nina went to the doctor last week for
her annual check-up. She had not been “feeling herself ” for the last
several months. Upon examination, Mrs. Nina learned that she has
hypertension and elevated cholesterol values. Life has not been the
same since. Mrs. Nina started having some chest pain, which was
attributed to anxiety regarding her diagnosis. Now, in addition to
acetaminophen, Mrs. Nina is taking lisinopril and
hydrochlorothiazide to treat hypertension and atorvastatin to treat
cholesterol levels.
• What is lisinopril and what is its role in the treatment of
hypertension?
• Are there any dental concerns associated with lisinopril?
• What are the dental concerns associated with antihypertensive
therapy? Counsel the patient about them.