2023+意大利实践指南:高血压和牙周炎.pdf
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1、Vol.:(0123456789)High Blood Pressure&Cardiovascular Prevention https:/doi.org/10.1007/s40292-022-00553-2CLINICAL GUIDELINES ANDPRACTICE RECOMMENDATIONSPractical Guidelines forPatients withHypertension andPeriodontitisDavidePietropaoli1,2 FrancescoCairo3 FilippoCitterio4 FrancescoDAiuto5 ClaudioFerri
2、6 GuidoGrassi7,8 LucaLandi9 ClaudioLetizia10 StefanoMasi11,12 MariaLorenzaMuiesan13,14 GuerinoPaolantoni15 NicolaMarcoSforza16,17 RitaDelPinto2,6 the Italian working group on Hypertension and Periodontitis(Hy-Per Group)Received:31 October 2022/Accepted:12 November 2022 The Author(s)2023AbstractArter
3、ial hypertension(AH)and periodontitis are among the most common non-communicable chronic diseases worldwide.Besides sharing common risk factors,an increasing body of evidence supports an independent association between the two conditions,with low-grade systemic inflammation acting as the plausible b
4、iological link with increased cardiovascular risk.In 2021,the Italian Society of Arterial Hypertension(SIIA)and the Italian Society of Periodontology and Implantology(SIdP)have joined forces and published a joint report on the relationships between AH and periodontitis,reviewing the existing scienti
5、fic evidence and underlining the need to increase awareness of the strong connection between the two con-ditions and promote treatment strategies for the control of gums inflammation in patients with AH.The current document extends the previous joint report,providing clinical practical guidelines ai
6、med to support clinicians in the management of patients who suffer from or are at risk of being affected by both conditions.These recommendations are based on careful consideration of the available evidence as well as of the current guidelines on the management of periodontitis and AH and are suppor
7、ted by SIIA and SIdP.Keywords Hypertension Periodontitis Practice guidelines1 IntroductionArterial hypertension(AH)and periodontitis are among the most common chronic diseases in the world,and they can significantly affect peoples health and well-being 1.AH is the most relevant risk factor for cardi
8、ovascular diseases,which are still the main cause of death in the world and affects about 1 in 3 Italians,half of whom are unaware.Simi-larly,periodontitis,a chronic non-communicable disease of the supporting tissues of the teeth,affects up to 50%of the worlds population,with about 3 millions Italia
9、ns suffering from severe forms and running an imminent risk of tooth loss 2.In 2021,the Italian Society of Arterial Hypertension(SIIA)and the Italian Society of Periodontology and Implan-tology(SIdP)have joined forces and published a Joint report on the relationships between AH and periodontitis,rev
10、iew-ing the existing scientific evidence and underlining the need to promote strategies that aim to control gums inflammation in the management of patients suffering from AH 3.The current document extends the previous joint report,providing clinical practical guidelines aimed to support cli-nicians
11、in the management of patients affected or at risk of being affected by both conditions.These recommendations are based on careful consideration of the available evidence as well as of the current guidelines on the management of hypertension and periodontitis and are supported by SIIA and SIdP.*Claud
12、io Ferri claudio.ferriunivaq.it*Luca Landi Extended author information available on the last page of the article D.Pietropaoli et al.Practical Recommendations 1.Measuring blood pressure and diagnosis of AH 2.Diagnosis of gingivitis/periodontitis 3.Assessing common risk factors 4.Identifying patients
13、 with gingivitis/periodontitis at risk for AH 5.Identifying patients with AH at risk of gingivitis/periodontitis 6.Patient information to increase the level of aware-ness 7.Identifying whom to refer patients at risk 8.Step 1,2 and 3 of periodontal therapy 9.Follow-up and supportive care 10.Integrate
14、d care pathways 11.Recommendations for healthcare providers 12.Essential bibliography1.Measuring blood pressure and diagnosis of AHA correct blood pressure(BP)measure is crucial to reach an accurate diagnosis of AH,define the severity of the condi-tion,prescribe appropriate treatments,and plan the p
15、atients follow-up.The most widely used method to screen for AH is based on the measure of BP values in a health care setting(by a physician,a nurse,a pharmacist,or a dentist),referred to as Office Blood Pressure Monitoring(OBPM)4.A single BP recording is insufficient to reach a final diagnosis of AH
16、,which instead should be made after repeated BP measure-ments 4.These might be acquired:(a)in the same health care setting of the screening visit,if there is the experience in measuring BP or(b)through an ambulatory BP monitoring(ABPM),which records the BP values over 24 h(a minimum of 70%usable BP
17、recordings are required for a valid ABPM measurement session)or(c)through home BP monitoring(HBPM),which repre-sents the average of all BP readings performed with a semiautomatic,validated BP monitor,for at least 3 days(and preferably for 67 consecutive days)before each clinical visit.When the HBPM
18、is used to confirm the diagnosis of AH,patients should be instructed to acquire at least two BP measurements 12 min apart for each recording,and record-ings should be performed in the morning and the evening 4.The method used to confirm the diagnosis of AH should take into account the availability o
19、f ABPM devices,the indi-viduals ability to acquire accurate BP values at home,the suspect of secondary forms of AH(i.e.obstructive sleep apnea syndrome)and the severity of BP elevation recorded during the first screening.Independently of the method used to confirm the diag-nosis of AH,all individual
20、s with elevated BP values at a first screening should receive adequate training on the most appropriate method to measure BP at home.1.1 BP measurements should be acquired in a quiet environ-ment after 5 minutes of resting in a seated position.1.2 Acquisitions should be carried out under conditions
21、of mental and physical well-being,as measurements taken in the presence of symptoms(pain,anxiety,stress)are generally associated with increased BP values that do not represent the real BP control of the patient.1.3 Measurements should be taken with a bladder cuff placed around the upper arm at the l
22、evel of the heart.The cuff size should be appropriate for the size of the patients arm(obese individuals should use larger cuff sizes to avoid overestimation of BP values).1.4 The acquisition of the first measurement should be fol-lowed by a second and third measurement,spaced at least 23 min apart.
23、1.5 A progressive decrease of BP in repeated measurements is often observed in individuals with a white coat effect or an alert reaction to BP measurement.In these cases,the patients final BP value should be considered asthe average of at least 2 BP measurements taken consecu-tively and for which th
24、e difference in systolic BP should be 3 mm are defined as pockets,which in gen-eral present subgingival bacterial colonization and benefit from scaling,with CAL gain and PD reduction after treat-ment.REC is the distance between the CEJ and the gingival margin.BOP assessment consists of the recording
25、 of the presence of bleeding at a specific site after gentle probing with the periodontal probe.BOP is strictly correlated with the presence of inflammation in the periodontal tissues.Full-mouth assessment at 4-to 6-sites per tooth is required.2.1 A patient with at least 10%of the sites with BOP is
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- 意大利 实践 指南 高血压 以及 牙周炎
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