The appropriate modifications for differing stages of hypertension is outlined in the algorithm presented below. There are, however, several areas of general dental management to be considered in the hypertensive patients. The use of vasoconstrictors such as epinephrine in local anesthetic agents is known to have negligible influences on blood pressure in hypertensive patients, according to numerous clinical studies. Data in regard to epinephrine-containing local anesthetics has consistently shown that blood pressure and heart rate are minimally affected by the typically low dose and short duration of the drug use in dentistry, both in healthy and those with existing cardiovascular conditions. Nonetheless, the use of epinephrine-containing anesthetics in patients with uncontrolled hypertension, and elective dental procedures are contraindicated.
All antihypertensive drugs are potentiated by general anesthetic agents, especially barbiturates.
General anesthesia tends to cause vasodilation. A severely reduced blood supply to vital organs can be dangerous in healthy individuals, but in the hypertensive person with vascular disease there is greater risk as the tissues have become adapted to a raised blood pressure which is needed to overcome the resistance of the vessels and maintain adequate perfusion. A fall in blood pressure below the critical level needed for adequate perfusion of vital organs such as the kidneys, can therefore be fatal. Hypokalemia as a result of diuretics may be associated with arrhythmias. The anxiety and stress associated with dental treatment typically causes a rise in blood pressure and may precipitate cardiac arrest or a cerebrovascular accident.