Elevated blood pressure: dental considerations

For the medical management of elevated blood pressure, see Blood pressure reduction.

Patients treated for elevated blood pressure can undergo general dental treatment if their blood pressure is controlled and stable.

Although local anaesthetics containing adrenaline (epinephrine) theoretically elevate blood pressure, they do not have a clinically significant effect (see Adding vasoconstrictors to local anaesthetics).

Avoid nonsteroidal anti-inflammatory drugs (NSAIDs) in patients taking a diuretic plus an angiotensin converting enzyme inhibitor (eg perindopril) or an angiotensin II receptor blocker (eg candesartan). Combining these three drug classes can cause kidney failure. Alternate analgesics (eg paracetamol) are recommended (see Choice of analgesic for acute dental pain).

Calcium channel blockers (eg amlodipine) can cause gingival enlargement (gingival hyperplasia). Gingival enlargement can be minimised with good oral hygiene; however, extensive gingival hyperplasia requires specialist management.