Hypertension reduces the patient's ability to maintain a stable blood pressure and the dentist's attention is drawn to the need to take the following precautions:
- A precise history of all patients being treated for 'heart condition' or 'blood pressure', including the type and dosage of drugs taken, should be obtained and evaluated carefully.
- Care should be taken in the selection and administration of local anaesthetics, and preparations free of adrenaline and nor-adrenaline should be used. Felypressin is a safe and effective alternative. Where the dentist considers it essential to use adrenaline or nor-adrenaline its concentration should not exceed 1:200 000 (i.e. 5.0 ug/mL) and a maximum dose of 2 mL (1.0 ug) should be observed. Meticulous care should be taken to avoid intravenous injection.
- In addition to their effect on blood pressure some antihypertensive drugs, e.g. Rauwolfia, have a sedative effect, which reduces the dose of sedative drug needed during dental treatment. This should considered when selecting sedatives to allay anxiety.
- Undesirable fluctuations in blood pressure may be avoided by using appropriate sedation to reduce anxiety.
- Patients with hypertension may develop respiratory distress in the supine position; they may need to be treated in a more upright position. Sudden changes in position should be avoided, but if the blood pressure falls, the patient should be placed in the horizontal position.
- Patients who require major dental treatment or surgery should be treated where there are adequate staff and facilities for their care both during treatment and in the post-operative period. It is wise to arrange for such patients to be admitted to hospital.
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