Hypertensive Emergency

Hypertension is defined as a blood pressure (BP) ≥140/90 mm Hg. Hypertensive emergency (Table 6) is defined by a BP ≥180/110 mm Hg and signs and symptoms of severely elevated BP. The mechanisms that lead to severely elevated BP appear to be related to a failure of normal autoregulatory function resulting in increased vascular resistance caused by endogenous vasopressors in patients with unrecognized or under-treated hypertension; and/or following the administration of sympathomimetic drugs such as high doses of epinephrine.

Table 6. Hypertensive Emergency.

Prevention:

Identify at-risk patient

Reduce anxiety
Ensure profound local anesthesia

Use local anesthetic agents containing a vasoconstrictor congruent with the patient’s functional capacity

Signs and symptoms:

Restlessness
Flushed face
Visual disturbances
Dyspnea

Pulmonary edema/congestive heart failure

A “hammering” pulse
Altered mental state
Chest pain

Myocardial ischemia, infarction, or aortic dissection

Seizure

Hypertensive encephalopathy

Cerebral hemorrhage, coma, death

Emergency response:

Place patient in an upright or semi-reclining position

Activate EMS

Administer oxygen

4 to 6 L/min by nasal cannula

Monitor vital signs

If at any time the patient becomes unresponsive, no normal breathing, and no palpable pulse consider the diagnosis of cardiac arrest

Immediate CPR and defibrillation congruent with current recommendations

Nota bene:

In the oral healthcare setting, the BP should not be acutely lowered.

Tissue perfusion in the brain, heart, and kidneys is tightly regulated within a certain range of mean arterial pressure (MAP), abruptly decreasing the MAP can lead to significant drop in cerebral blood flow and, thus, cerebral ischemia.

Hypertensive urgency (BP ≥180/110 mm Hg, patient is asymptomatic)

Medical evaluation and risk modification within 24 to 48 hours - same day referral

Managing Adult Medical Emergencies in the Dental Office
Hypertensive Emergency