Biological relationship between body weight and blood pressure – A one year prospective study of patient in oral diagnosis and radiology clinic, University Of Benin Teaching Hospital

Madukwe I. U.

Department of Oral Surgery and Pathology, Faculty of Dentistry,
College of Medical Sciences, University of Benin, Benin City, Nigeria

ABSTRACT
Back ground: Overweight and high blood pressure are topical and challenging issues in healthcare but less stressed in dental care.
Aim: The aim of this study is to analyze the relationship between body weight and blood pressure in the patients attending dental clinic.
Methodology: This study was a one year prospective study of patients attending dental clinic between 2011-2012. African average adult weights (60.7kg) was used as baseline, above which constitutes overweight, while two times measurement and two times visit of physician classification 140/90mmHg was used as basis for blood pressure status.
Result: A total of 4756 patients were seen .50 %( 2378) were overweight and 2.6 %( 124) were hypertensive with weight range of (91-110kg). Grand average blood pressure of patients weighing 101-110kg was139.67/91.43mmHg.

Conclusion: We therefore conclude that blood pressure check is a necessity especially in overweight patients requiring dental procedures.

INTRODUCTION
Body weight is the weight of a person without any item located on the patient, but this is not practicable in the oral diagnosis clinic, where it is usually done with clothes on but often without the shoes and heavy accessories like mobile phones, wallet and bags.  It is concurrently taken with blood pressure.  In many centres focus is on divine ideal body weight[1], body mass index and the Hamni Method.  Here our focus is on average weight of an adult which is 70kg with a height of 1.75 metres, African average adult weight 60.7kg, with an overweight population of 28.9% of 535 million (154.62 million).[2]  Abdulle et al[3] and Fah et al[4] in their study revealed a strong relationship between high blood pressure and body weight, even in pregnancy[5] and confirmed by Framingham Heart Study, a famous study for 44 years estimated that excess body weight accounted for approximately 26% of cases of hypertension in men and 28% in women[6].  In this study therefore, over weight referred to weight above established African value of 60.7kg,2 and high blood pressure referred to physicians classification of values stage I – systolic 140 – 159/diastolic 80 90mmHg; stage 2 – Systolic > 160mmhg / diastolic > 100mmHg and is based on the average of two or more properly measured blood pressure readings at each of two or more visits after an initial screening.[7]

METHODOLOGY
This study was prospective in an oral Diagnosis and Radiology Clinic.  This clinic is the first point of visit for patients attending the Dental Centre.  Here diagnosis is made before patients are referred to appropriate clinic for definitive treatment.  It was a one year prospective study( 2011-2012) of oral diagnosis clinic attendance archive. Data forAfrican average adult weight (60.7kg)2 was used as base line above which constitutes over weight.1  Blood pressure was measured using student sphygmomanometers.  Patient on regular medications were excluded.  Medication defaulters were included with the fresh patients.  Two times measurement, two time visit of stage I physician classification 140/90 were used as basis for blood pressure status.

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RESULTS
Tables 1a, b, c, g, I, j, k, l, showed overweight and blood pressure. Weight 101-110kg showed values > 140/90mmHg physician classification. Tables h, j, l, weight 91-100kg showed valuesgreater than 140/90mmHg physician classification. African average adult weight is 60.71kg.[2] Tables 1a-g I,k,m, 61-100kg are normotensive except tables j and l.  Average values of blood pressure by weight group 139.67/91.43mmHg (Table II) and average values of blood pressure from over-weight  (97 – 110kg) group is143.21/96.67.

DISCUSSION
The interrelationships between hypertension and overweight, two common and major health hazards is a challenge.  Overweight hypertensive patients are likely to experience coronary heart disease.  These two combinations are likely to pose serious challenges of morbidity and mortality[8], as confirmed by Mertens and Van Gral.[9-10] In an overweight adult, study population of 50% (2378/4756) Tables I & II. (against African 28.9%), Average values of blood pressure from total study population of 4756 by weight group showed 101-11-kg body weight as 139.67/91.43mmHg (Table II). This is significant, more so when the average value of blood pressure from hypertensive group from overweight adult population of 2378 (50%) (Table III) 143.21/96.67mmHg.  This represents 4.96% hypertensive overweight population.
This study sensitizes the mind for the need to continue blood pressure checks on all dental patients. As dentophobia been linked with elevation of blood pressure in patients visiting dental clinic. This may be due to the previous dental experience.

CONCLUSION
We therefore conclude that blood pressure checks is a necessity especially in overweight patients requiring dental intervention.

REFERENCES

  1. Pai Manjunath, B., P. Palonoek, Frank P.  The origin of the “Ideal body weight Equation.  The Annals of Phamacotherapy 2000, 34(9), 1066 – 1069.,
  2. Walpole Sarah C., Prieto-Merino David; Edwards Phil; Cleland John; Stevens, Gretchen; Roberts Ian, The weight of nations: an estimation of adult human Biomass.  BMC Public Health, June 2012, 12; 439.
  3. Abdulle, A., Al-Junaibi A., Nagelkerke N.  High blood pressure and its association with body weight among children and adolescents in the United Arab Emirates.  PL05 one.  2014 Jan. 20, 9(1): e, 85129.
  4. Fah CA, Smith DL, Horn GP, Agiovlasitiss, Rossow LM, Echols G., Heffeman KS, Fernhall B.  Impact of excess body weight on arterial structure, functional blood pressure in fire fighters.  AM J. Cardiol. 2009 Nov. 15; 104 (10): 1441-5.
  5. Magriples U., Boynton MH, Kershaw, TS, Duffany KO, Rising SS, Ickovics JR.  Blood pressure changes during pregnancy:  Impact of race, body mass index, and weight gam.  AM J. Perinatol. 2013 May: 30(5) 415 – 21.
  6. Laner, MS, Anderson KM, Kannel WB, Levy D.  The impact of obesity on left ventricular mass and geometry.  The Framingham Study.  JAMA 1991; 266 – 231.
  7. Chobian, AV., Bakris, GL, Black, HR et al.  The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and treatment of High Blood Pressure.  The JNC 7 Report.  JAMA 2003; 289: 2560.
  8. Chiang BN, Perlman LV, Epstein FH.  Overweight and hypertension – A review Circulation – American Heart Assocation 1969; 39-403-421.
  9. Mertens IL, Van Gaal LF, Overweight, obesity and blood pressure:  Effects of modest weight reduction.  Obes Res. 200mg 8; (3): 270 -8.
  10. Piccirillo G, Vetta F, Viola E, Santagada E, Ronzoni S, Lacciafesta M, Marigliano V. Int. J. Obes. Relat. Metab. 1998 Aug., 22(8): 741-50.
  11. American psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, pp. 271-280.