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Medical Emergencies · patient case with 2 questions

Elevated blood pressure and swollen gums

Patient: Male, 62 years old

Chief Complaint: “My gums have grown over my teeth.”

Background: Hypertension for eight years and angina. Current medications: nifedipine, atorvastatin, low-dose aspirin. Non-smoker. He reports brushing twice daily.

Vital Signs: BP 145/92 mmHg (repeated, seated, correct cuff) · HR 76 bpm · RR 16

Findings: Firm, fibrotic, nodular enlargement of the interdental papillae, most pronounced anteriorly and facially. Moderate plaque. No spontaneous bleeding.

Question 1

Under the 2017 ACC/AHA guideline, how is a blood pressure of 145/92 mmHg classified?

  1. Elevated blood pressure
  2. Stage 2 hypertension
  3. Stage 1 hypertension
  4. Hypertensive crisis
Show answer and explanation

Correct answer: B. Stage 2 hypertension

  • A. The elevated category has a diastolic under 80 by definition; 92 excludes it.
  • B. CORRECT. The 2017 ACC/AHA thresholds are: normal below 120/80; ELEVATED 120–129 systolic with diastolic under 80; STAGE 1 at 130–139 or 80–89; STAGE 2 at 140 or above, or 90 or above. When systolic and diastolic fall in different categories, the HIGHER one governs. At 145/92 both values sit in stage 2.
  • C. Stage 1 tops out at 139/89. Both of this patient's numbers exceed that.
  • D. Hypertensive crisis begins at 180/120, at which point elective dental care is deferred and the patient needs urgent medical evaluation.

Note: Under the older JNC 7 framework 145/92 was Stage 1, and some recall documents in this series still use that scale. INBDE follows the 2017 ACC/AHA guideline, so 140/90 and above is Stage 2.

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Question 2

Which of this patient's medications is most likely responsible for the gingival enlargement?

  1. Nifedipine
  2. Atorvastatin
  3. Aspirin
  4. None — this is purely plaque-induced
Show answer and explanation

Correct answer: A. Nifedipine

  • A. CORRECT. NIFEDIPINE is a dihydropyridine calcium channel blocker and the classic drug cause of gingival enlargement in a cardiac patient. The three drug classes to know are calcium channel blockers (nifedipine, amlodipine, verapamil), the anticonvulsant PHENYTOIN, and the immunosuppressant CICLOSPORIN. The mechanism involves altered calcium flux in gingival fibroblasts leading to excess collagen accumulation; plaque is a necessary co-factor, which is why the enlargement is worst where hygiene is poorest.
  • B. Statins have no association with gingival overgrowth. Their adverse effects are myopathy and transaminase elevation.
  • C. Aspirin causes prolonged bleeding, not tissue overgrowth.
  • D. Plaque alone produces oedematous, red, bleeding tissue. The firm, fibrotic, nodular quality described here points to a drug-influenced enlargement superimposed on plaque.

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