The Saskatchewan Dental Hygienists’ Association Hypertension Protocol states to take blood pressure: • At the first appointment of all new patients 3 years of age and older • Annually • Each appointment if the patient has hypertension or is taking a medication for hypertension How to take blood pressure The following are the ideal techniques for taking blood pressure.1 • The patient should be seated at rest for at least 5 minutes before taking the blood pressure. • The patient should have an empty bladder. • The patient should not have had caffeine, smoked or exercised for at least 30 minutes before taking blood pressure. • The patient should be seated with a straight back, feet supported and legs uncrossed. • The cuff should be placed over a bare arm and supported at heart level. • The bottom of the cuff should be about 2.5 cm above the elbow crease. • The patient should not move or talk while the blood pressure is checked. • Wait 1 minute before checking the blood pressure again. Should I use a digital or aneroid blood pressure monitor? Aneroid blood pressure monitors are the gold standard for checking blood pressure and are more accurate than digital blood pressure monitors. Digital monitors have the advantages of being easier to use along with giving a visual reading for the provider and the patient. If using a digital blood pressure monitor, use one with a cuff for the upper arm, not the wrist, as wrist monitors give an elevated reading. Should we check blood pressure on the right arm or the left arm? The American Heart Association (AHA) recommends checking blood pressure on both arms at the first appointment and using the arm with the highest reading for future measurements. For children (under 18 years old), the blood pressure should be checked on the right arm as readings on the left arm may be lower due to the possibility of coarctation of the aorta.2 What is considered normal blood pressure? The American Heart Association and the American College of Cardiology’s Clinical Practice Guidelines state that normal blood pressure is less than 120 systolic mm Hg and less than 80 diastolic mm Hg. High blood pressure (stage 1) is 130–139 systolic mm Hg or 80-89 diastolic mm Hg. A hypertensive crisis is greater than 180 systolic mm Hg and/or greater than 120 diastolic mm Hg.3 (see Figure 1) When is blood pressure too low to provide dental treatment? There isn’t a specific reading that indicates the blood pressure is too low. A systolic reading less than 90 mm Hg and a diastolic reading less than 60 mm Hg is considered hypotension. A low blood pressure reading isn’t a concern unless the patient shows symptoms of low blood pressure such as weakness, nausea, fainting, lack of concentration, blurred vision, feeling light-headed, dizziness, or dehydration or unusual thirst. You can proceed with dental treatment if a patient has low blood pressure and none of these symptoms.4 When is dental treatment contraindicated due to high blood pressure? The College of Dental Hygienists of Ontario’s (CDHO) Advisory on Hypertension has tables with their advice Aneroid blood pressuremonitors are the gold standard for checking blood pressure and are more accurate than digital blood pressure monitors. 38 | 2024 | Issue 2 SupportingYour Practice
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