Volume 9 • 2022 • Issue 5

they are rushed or stressed about their appointment, it could elevate their blood pressure. Take the reading when the patient is sitting up straight with their feet flat on the floor and their arm is propped on an armrest at the level of the heart. Sometimes the automated machines will take one or two measurements to fully calibrate. Q What if a patient’s blood pressure remains high? AEM: If the patient seems calm and has tried the stress reduction protocol, but the readings are still elevated, then you should document their blood pressure and share it with their family physician. This is an opportunity for us to take on a role of advocacy for our patients and aid them in getting their hypertension diagnosed and managed by their family physician. Generally, if a patient’s systolic blood pressure is 160 or higher and diastolic is 100 or higher, then elective treatment should not be performed. If the treatment is emergent and dental pain may be contributing to the hypertension, then you can proceed with caution. However, you should be monitoring blood pressure by taking readings every 5 minutes. Hypertensive crisis is when systolic blood pressure is 180 or higher and diastolic is 110 or higher. If the patient has symptoms of end organ damage such as headache, dizziness, nausea, vomiting, chest pain, blurred vision or shortness of breath, they should go to the hospital emergency department. Q Why is it so important to diagnose hypertension? AEM: Uncontrolled high blood pressure increases the risk of serious health problems, including stroke, heart attack, chronic kidney disease, and congestive heart failure. Left undiagnosed and without management, hypertension can pose serious risk to a patient’s health and increase pressure on our healthcare system. Early diagnosis and management are key to preventing sequelae of the disease. As dentists, we can be an integral part of diagnosis of hypertension. Reference 1. Whelton PK, Carey RM, AronowWS, Casey Jr. DE, Collins KJ, Dennison Himmelfarb C, 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 Jun;71(6):1269-1324. The views expressed are those of the author and do not necessarily reflect the opinions or official policies of the Canadian Dental Association. Q What should a dentist do if a patient’s blood pressure is elevated? AEM: Measurements can be interpreted according to the latest guidelines on hypertension. The American College of Cardiology and American Heart Association published new guidelines in 2017. 1 There’s been a movement toward controlling blood pressure more stringently. Previously, a systolic blood pressure of 140 and a diastolic of 90 was considered stage one hypertension. That has changed. Now, stage one hypertension is a systolic blood pressure of 130 and a diastolic of 80. If a measurement is elevated, the question arises: is it acutely or chronically elevated? If you do see a measurement that is high, a stress reduction protocol should be used. For this protocol, communicate with your patient in a calm and soothing voice. You can turn down operatory lighting, play calming music, or encourage your patient to perform breathing exercises. There are many apps available with great breathing exercises that you can try. If the stress reduction protocol lowers the next reading, then the elevation was likely acute. It can also be helpful to ask your patients if they check their blood pressure at home on a regular basis. Dental anxiety could also cause acute elevation, so they may be fine at home or at the pharmacy and only produce high readings at the dental office. I would take three blood pressure readings and interpret the average of those three readings. If the average is normal, or if it is elevated due to fear, anxiety or stress, but the systolic blood pressure is below 160 and the diastolic is 100, then it is safe to proceed with treatment. Dental anxiety could also cause acute elevation, so they may be fine at home or at the pharmacy and only produce high readings at the dental office. Dr. El-Mowafy discusses hypertension and the role of dentists on CDA Oasis: bit.ly/3RcrOQA 32 | 2022 | Issue 5 Issues and People