Management of Controlled Hypertensive Patients Undergoing Dental Extraction and Filling

Preoperative Assessment and Medication Management

Patients with controlled hypertension can safely proceed with tooth extraction and filling while continuing their antihypertensive medications, and local anesthetics containing epinephrine can be used safely without significant hemodynamic complications, according to the American Heart Association 1, 2
Proceed with dental treatment if systolic BP <180 mm Hg and diastolic BP <110 mm Hg, as recommended by the American College of Cardiology 1, 3, 4
Defer elective procedures if BP ≥180/110 mm Hg until better control is achieved, as this threshold is associated with increased perioperative cardiovascular complications, according to the American College of Cardiology 1, 3

Continue all antihypertensive medications on the day of the dental procedure, as advised by the American Heart Association 5, 6, 3
Beta-blockers and clonidine must never be stopped abruptly due to risk of rebound hypertension, which can be life-threatening, according to the American College of Cardiology 3, 4, 7
ACE inhibitors and ARBs may be considered for temporary discontinuation 24 hours before the procedure if the patient has risk factors for hypotension, though this is controversial and not mandatory for routine dental procedures, as noted by the American College of Cardiology 3, 4

Epinephrine-containing local anesthetics are safe and can be used in controlled hypertensive patients, according to the American Heart Association 1, 2
Monitor blood pressure during the procedure if general anesthesia or sedation is used, as hypertensive patients may experience wider BP fluctuations and risk of hypotension when receiving antihypertensive drugs, as recommended by the American Heart Association 1, 2

Resume or continue all antihypertensive medications immediately after the procedure, as advised by the American Heart Association 5, 6
Provide adequate postoperative pain control, as pain increases sympathetic tone and vascular resistance, according to the American Heart Association 1
Do not proceed with elective dental surgery if systolic BP ≥180 mm Hg or diastolic BP ≥110 mm Hg, as recommended by the American College of Cardiology 1, 3, 4