Hypertension in the Dental Office

Hypertension, or high blood pressure, is defined by the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 8) as having a blood pressure that exceeds 150/90 Hg in people 60 years old and above, and 140/90 Hg in people under 60. The Center for Disease Control (CDC) estimated that 75 million people in the United States currently live with some form of hypertension. Direct cause of hypertension has not been found to be caused by dental procedures (outside of white coat hypertension), however the medications commonly prescribed to treat hypertension may have antagonistic reactions with medications used in dental procedures.

The role of the dental office in reporting hypertension

The dental office can play an important intermediary role between a patient and their GP by way of referral upon discovering hypertension. One report found that when blood pressure screening took place in the dental office, 6% of patients were later referred to a general practitioner for discovered hypertension, and that 6% of these referred patients would see their dentist annually but their GP less so.  

White Coat Hypertension

One form of hypertension to be cognizant of for dental practitioners is termed “white coat” hypertension. It refers to individuals who are otherwise healthy in regards to blood pressure, but who experience a form of acute onset hypertension due to stress of oncoming medical procedures. These individuals will experience normal blood pressure readings at home, but abnormally high blood pressure readings in medical settings.

Treatment of Hypertension

Antihypertensive medications commonly work through baroreceptors or by stimulating epinephrine or norepinephrine. The main classes of antihypertensive medications are:

  • Beta-Blockers

  • ACE inhibitors

  • Angiotensin II receptor blockers

  • Calcium channel blockers

  • Alpha-blockers

  • Diuretics

  • Direct-acting vasodilators

  • Central-acting agents

Common Oral Side Effects

  • Dry Cough

  • Taste changes

  • Dry mouth

  • Angioedema of the lips, face, and tongue

  • Gingival hyperplasia

  • Lichenoid reactions

  • Lupus-like oral and skin lesions

Consideration of dental surgeries in relation to prescribed anti-hypertension medication is important in ensuring avoidance of harmful drug-drug interactions. For example, epinephrine is commonly used with local anesthetics and can interact negatively with beta-blockers. Below are the Journal of the American Dental Association's’ recommendations for dental procedures based on the severity of hypertension.

BP Category

Systolic BP, mm Hg

Diastolic BP, mm Hg

Diastolic BP, mm Hg<120<80
Hypertension (stage 1)130-13980-89
Hypertension (stage 2)≥140≥90
Hypertensive Crisis>180>120