Evaluation of the effect of long-term use of antihypertensive drug on bone density with dental volumetric tomography

Hypertension (HT) or high blood pressure is the mean arterial blood pressure above the normal values. HT is a systemic disease that manifests itself with persistently elevated blood pressure, and has become an important health problem because it causes serious complications and is common in the community. Untreated hypertension; heart failure, coronary heart disease, hemorrhagic and thrombotic stroke, kidney failure, peripheral artery disease, aortic dissection, and increased mortality rates. The intended goal in the treatment of HT is to reduce morbidity and mortality as much as possible. Drugs used in the treatment of HT are classified in 5 groups. These; diuretics, sympatholytics or adrenergic nervous system antagonists, drugs that affect the renin-angiotensin system, drugs that act on vascular smooth muscle, and drugs under development. Osteoporosis means that bones become much more fragile due to the extreme decrease in bone density. Osteoporosis is the most common form of metabolic bone disease. It is characterized by a parallel reduction in the matrix and minerals of the bone. In addition to other side effects, there is a risk of developing osteopenia and osteoporosis in long-term use in patients using antihypertensive drugs. Decreased bone density due to the use of antihypertensive drugs affects both genders and especially advanced age groups. Therefore, the use of antihypertensive drugs for more than two years and the age of 50 and over can be considered as risk factors that may affect bone density. In this thesis, we aimed to evaluate the effects of regular antihypertensive drug use on the cortical and trabecular bone of the mandible by performing radiomorphometric measurements on Dental Volumetric Tomographic (DVT) images. Our study was planned as a retrospective study to include patients diagnosed as hypertensive and using regular antihypertensive drugs. The study included male patients aged 25-75 years, who were diagnosed with HT at least 5 years ago and used regular antihypertensive drugs, who applied to Dicle University, Faculty of Dentistry, Oral and Maxillofacial Surgery Polyclinic with different complaints and received DVT due to various dental indications. The study was designed in 4 groups: Control Group (N = 60) - Patients between the ages of 25-75, who did not have any systemic disease and no regular medication. Calcium Channel Blocker Group (N = 60) - Patients between the ages of 25-75 who use long-term (5 years) Calcium Channel Blocker group drugs. Beta Blocker Group (N = 60) - Patients between the ages of 25-75 who use long-term (5 years) Beta Blocker group drugs. ACE Inhibitor Group (N = 60) - Patients aged between 25 and 75 years using long-term (5 years) ACE inhibitor group drugs. DVT images of all patients included in the study were evaluated with I-CAT vision software. As a radiomorphometric index; Dental Volumetric Tomographic Mandibular Index Inferior (DVT-MII), Dental Volumetric Tomographic Cortical Index (DVT-KI), Hounsfield Unit - Cortical (HU-CORTIAL), Hounsfield Unit -Spongiosis (HU-SPONGIOS) were used. Radiomorphometric indices were measured on sections taken from the right side of the patient in panoramic and implant mode of DVT images. The values of DVT-MII, HU-CORTIAL parameters belonging to four different groups included in the study, one-way analysis of variance (ANOVA) and the values of DVT-KI and HU-SPONGIOZ parameters were compared with the Kruskal Wallis Test - Mann Whitney-U test. According to the results of our thesis study, it was observed that long-term use of Ca Channel Blocker group antihypertensive drugs had negative effects on the bone tissue of the patients, while the use of Beta Blocker and ACE Inhibitor group antihypertensive drugs was not statistically significant when compared to the Control group. As a result, it is very important for dentists to be aware of the side effects of antihypertensive drugs in preventing the risk of osteoporosis and osteopenia in hypertensive patients. Dentists have a very important place in the selection and dose adjustment of drugs suitable for the patient in hypertensive patients at risk of osteoporosis.