Cardiovascular
Dental Management of Patients with Hypertension
Record blood pressure before treatment
Blood pressure has not been recorded. Measure in-chair before any procedure.
Emergency vs routine management
If EMERGENCY — what to do
- • Measure BP before treatment.Ref: Whelton PK et al. 2017 ACC/AHA Guideline for High Blood Pressure in Adults. Hypertension 2018;71:e13–e115
- • BP < 180/110: treat the emergency with stress reduction and limited adrenaline.Ref: Little JW, Miller CS et al. Dental Management of the Medically Compromised Patient, 10th ed., Elsevier 2023
- • Limit adrenaline to 0.04 mg (≈ 2 cartridges of 1:80,000–1:100,000), aspirate and inject slowly.Ref: Little JW, Miller CS et al. Dental Management of the Medically Compromised Patient, 10th ed., Elsevier 2023
- • BP ≥ 180/110: no elective work — palliative care only (drainage, pulp extirpation, analgesics) and same-day physician referral; if headache, chest pain or visual disturbance call emergency services.Ref: Whelton PK et al. 2017 ACC/AHA Guideline for High Blood Pressure in Adults. Hypertension 2018;71:e13–e115
If ROUTINE — what to do
- • < 160/100: routine care.Ref: Little JW, Miller CS et al. Dental Management of the Medically Compromised Patient, 10th ed., Elsevier 2023
- • 160–179 / 100–109: proceed with stress reduction, limited adrenaline and BP re-check; refer for review.Ref: Little JW, Miller CS et al. Dental Management of the Medically Compromised Patient, 10th ed., Elsevier 2023
- • ≥ 180/110: defer elective treatment until controlled.Ref: Whelton PK et al. 2017 ACC/AHA Guideline for High Blood Pressure in Adults. Hypertension 2018;71:e13–e115
- • Avoid prolonged NSAIDs (reduce antihypertensive effect).Ref: British National Formulary (BNF) — Prescribing in renal impairment, hepatic impairment & drug interactions (current edition)
Clinical precautions
- • Measure and document BP prior to treatment
- • Use stress-reduction protocol
Information & tests to request
- • Systolic BP (mmHg)
- • Diastolic BP (mmHg)
At a glance by procedure
Initial assessment before lab results or timing details are entered.
| Procedure | Initial assessment |
|---|---|
| Examination / radiographs | MODIFY / CAUTION Record blood pressure before treatment |
| Supragingival scaling / polish | MODIFY / CAUTION Record blood pressure before treatment |
| Deep scaling / subgingival RSD (subgingival calculus) | MODIFY / CAUTION Record blood pressure before treatment |
| Root canal treatment | MODIFY / CAUTION Record blood pressure before treatment |
| Simple extraction (1–3 teeth) | MODIFY / CAUTION Record blood pressure before treatment |
| Surgical / bony extraction | MODIFY / CAUTION Record blood pressure before treatment |
| Implant placement | MODIFY / CAUTION Record blood pressure before treatment |
References
- AHA/ACC Hypertension Guideline
- Whelton PK et al. 2017 ACC/AHA Guideline for High Blood Pressure in Adults. Hypertension 2018;71:e13–e115
- Little JW, Miller CS et al. Dental Management of the Medically Compromised Patient, 10th ed., Elsevier 2023
- British National Formulary (BNF) — Prescribing in renal impairment, hepatic impairment & drug interactions (current edition)
Related guides
Myocardial infarction (history)Congestive heart failureProsthetic heart valve (mechanical)Bioprosthetic / tissue (animal) valvePrevious infective endocarditisCoronary stent (on DAPT)
This guide supports — and does not replace — professional clinical judgment. Always consider the individual patient and consult the treating physician when indicated.