- Changes in class of antihypertensive medications, as well as change in dosages suggests a more severe disease.
- Patients exhibiting signs and symptoms of high blood pressure are at higher risk for an adverse event.
- Patient’s measured blood pressure in combination with target organ diseases will determine modifications for routine dental care. (See the table below.)
- A systolic blood pressure >150 mm Hg may predispose a patient with a recent (within 120 days) non-cardio-embolic ischemic stroke to a recurrent stroke.
- Individuals who have not met recommended blood pressure goals should be referred to their physician.
- There may be an association between periodontal disease and the development of higher blood pressure (see Agilera EM, et al. below).
Oral care consideration
|Patients with controlled hypertension.||No modifications are necessary.|
|Asymptomatic patients with BP <150/100 mm Hg and no history of target organ damage.||No modifications are necessary.|
|Asymptomatic patients with BP 150-179/100-109 mm Hg and no history of target organ damage.||Assess on an individual basis and with regard to the type and duration of the dental procedure. Be aware of an increased risk for a recurrent ischemic stroke.|
|Patients with BP >180/110 mm Hg and no target organ damage.||Avoid elective dental care. Treat emergencies with analgesics and antibiotics as needed.|
|Patients with target organ damage, other signs and symptoms of elevated BP, or poorly controlled diabetes.||Emergency care with analgesics and antibiotics as needed when BP is uncontrolled (>140/90 mm Hg or >130/80 mm Hg for patients with DM).|
|Hypertensive urgency||:warning:Avoid elective dental care. Treat emergencies with analgesics and antibiotics as needed.|
|Hypertensive emergency||:warning: Avoid elective dental care. Treat emergencies with analgesics and antibiotics as needed.|
High Blood Pressure
| Drugs/ drug|
See Medical Complexity Status for more information.
- Medical Disorders
- Medical Emergencies
- Classifications and Definitions
- Agilera EM, et al. Association between periodontitis and blood pressure highlighted in systemically healthy individuals. Hypertension. 2021;77:1765–1774.
- Brouwers S, et al. Arterial Hypertension. Lancet 2021; 398: 249–261.
- Casey DE, et al. 2019 AHA/ACC Clinical Performance and Quality Measures for Adults With High Blood Pressure. A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures. Circ Cardiovasc Qual Outcomes. 2019;12:e000057.
- Glick M. The new blood pressure guidelines. A digest. JADA 2004;135(5):585-586.
- Go AS, et al. An effective approach to high blood pressure control: a science advisory from the American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention. Hypertension. 2014;63(4):878-85.
- Miller CS, et al. 2017 Hypertension guidelines. JADA. 2018;149(4):229-31.
- Ostchega Y, Nwankwo T, Chiappa M, Wolz M, Graber J, Nguyen DT. Comparing blood pressure values obtained by two different protocols: National Health and Nutrition Examination Survey, 2017–2018. National Center for Health Statistics. Vital Health Stat 2(187). 2021.
- Ovbiagele B, et al. Level of systolic blood pressure within the normal range and risk of recurrent stroke. JAMA 2011;306(19):2137-2144.
- Unger T, et al. 2020 International Society of Hypertension global hypertension practice guidelines. J Hypertension. 2020; 75: 1334–1357.
- Whelton PK, et al. 2017 - ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary—a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71(6):e13-e115.
- Williams B, et al. 2018 practice guidelines for the management of arterial hypertension of the European society of cardiology and the European society of hypertension ESC/ESH task force for the management of arterial hypertension. Eur Heart J 2018; 39: 3021–3104.
- 2014 Evidence-based guideline for the management of high blood pressure in adults. Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507-520.