Points to consider when treating patients with high blood pressure

Japan: Dental treatment is essential for the preservation of good health, but it is important to consider the medical conditions of patients when carrying out procedures. Hypertension and heart disease are two conditions that require extra care during dental treatment.

According to the Japanese Society of Hypertension, about 43 million people in Japan suffer from high blood pressure, and many of them take antihypertensive drugs. The director of Kobayashi Dental Hospital, Dr Yuki Kobayashi, has advised that patients with high blood pressure must be checked for their blood pressure level and medication status during the pre-treatment consultation.

Postpone Dental Appointment if Blood Pressure Too High

Patients whose blood pressure is above 180/120 should temporarily postpone dental treatment and prioritise blood pressure treatment. Kobayashi Dental Hospital also uses a monitor to measure the blood pressure of hypertensive patients during surgical treatment to prevent bleeding and other complications.

During dental treatment, the concentration of catecholamines in the blood increases, causing a sharp rise in blood pressure. If the RPP value, calculated by “maximum blood pressure × heart rate,” exceeds 14,000, the treatment is interrupted and restarted after the RPP value returns to the normal range of 7,000 to 12,000.

Pay Attention to Patient’s Drug Use

According to the Society, patients with high blood pressure must pay attention to the anaesthetic drugs used during dental treatment. Some anaesthetics contain vasoconstrictors, such as epinephrine, which temporarily increase blood pressure after injection.

Hypertensive patients should inform their dentists about their history of hypertension, blood pressure data, and information about the medications they are taking to avoid complications during dental treatment.

People who suffer from heart and blood vessel diseases or take anticoagulant and antiplatelet drugs for prevention should also be careful when receiving dental treatment, warns the Society.

These drugs prevent the formation of thrombus and are used to prevent angina pectoris, yocardial infarction, cerebral infarction, and other diseases. Patients who take these drugs have a higher risk of bleeding during dental treatment such as tooth extraction.

Change in Protocol

In the past, before treatment, the doctor who prescribed the drug needed to confirm the blood flow, and only after stopping the drug for a period of time could surgical treatment proceed. However, stopping the medication for dental treatment has caused myocardial infarction death and severe thromboembolism in some patients, leading to a shift in the direction of complete hemostasis without stopping the medicine.

Patients who take anticoagulants will undergo the “PT-INR” check value during surgical and dental treatment to manage drug dosage. Patients should inform their dentists about their medical history and drug dosage to avoid complications during dental treatment.