Hypertension and High Blood Pressure - Oral Health Care Considerations

• 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).

Hypertension control	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.

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Medical Complexity Status - Hypertension and High Blood Pressure

Hypertension/ High Blood Pressure	MCS1B	MCS2C
Anticipated complication	Controlled/ stable	Uncontrolled/ unstable
Hemostasis	None	None
Microbial  susceptibility	None	None
Drugs/ drug  interactions	Minor	Minor
Stress/trauma	None	Major

See Medical Complexity Status for more information.

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Related Pages

• Medical Disorders
  • Angina
  • Cardiovascular Disease
  • Diabetes
  • Heart Attack
  • Heart Failure
  • Hypertension
  • Kidney/Renal Disease
  • Stroke
  • Transient Ischemic Attack
• Medications
  • Anti-hypertensive medications
• Medical Emergencies
  • Chest Pain
  • Hypertensive crisis
  • Unresponsive Patient
• Images
  • Gingival Overgrowth - Calcium Channel blocker
• Classifications and Definitions
  • Hypertension
  • Metablic Syndromne

References/Websites

• References
  • 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.