As you can tell by the title of this blog, I have a strong opinion about the importance of taking blood pressure, and with good reason.  

Questions to ask yourself as a provider:

• Do you see any patients over 50 years old?  
• Any patients who are overweight?  
• What about males?  
• Any patients of African descent?   

If you answered “yes” to any of these questions, I guarantee you have patients with hypertension.  

What is Hypertension, and Why is it Important?

Hypertension or high blood pressure is common in the US and if you are giving anesthesia you need to get a reading.  

I know you have seen him before. Let’s call him Larry. He is in his late 50s, a big man who has important things to do. He arrives late, is out of breath, red-faced and sweating. He is scheduled for 2 quads of SRP. His blood pressure is 169/115. Do you reschedule?  Do you limit to a cardiac dose?  Do you ignore it?   What does that number mean?  

Understanding Blood Pressure Readings.

The top number in a blood pressure reading indicates systolic pressure. That measures the pressure in your arteries when your heart beats. The bottom number is the diastolic pressure and measures the pressure of your heart between beats.  Which is more important? It is worse to have elevated systolic than diastolic?  No, both numbers are equally important when evaluating heart health. The chart below is just one of several that I give my students in the Local Anesthesia for the Dental Hygienist course. Feel free to download and save it!

Recommendations for Stage 2 Patients

Most of us are good treating patients up to stage one. Most of us are good at recognizing hypertensive crisis and activating EMS if needed. But Larry is stage 2 and that makes it tricky.  In my office, we retake a reading after five minutes.  Since he is a big man, I prefer the second reading with a manual cuff.  Still 169/115.  My recommendation is physician referral and reschedule. Have I treated patients with the same number? Yes, but in those cases, the patient was in moderate pain and fell into my definition of dental emergency.     

Policies To Adopt In Your Practice

You are a medical professional with your own license. In the end, you will be responsible for the choices you make. Stage 2 hypertension is a range between 141/91 to 179/119. Most of us will treat a patient with low stage 2 but few of us want to see a hypertensive emergency. I strongly recommend knowing your cut off number.  “We believe your heart is as important as your teeth. Our office policy is to reschedule treatment for any patient with repeated over 160/100.” Create a policy with a cut off number.  It’s easier for you and healthier for them.