A patient presents for a routine restorative appointment. Blood pressure is 180/110 mmHg. He is asymptomatic and reports no other history. What is the BEST management?

Correct answer: D. Defer elective treatment and refer for prompt medical evaluation

• A. ❌ Nitroglycerin is for angina/ischemic chest pain. Giving it to an asymptomatic hypertensive patient can cause a precipitous drop in pressure.
• B. ❌ Elective treatment should not proceed at this level regardless of the anesthetic used.
• C. ❌ EMS activation is reserved for a HYPERTENSIVE EMERGENCY — severe hypertension WITH evidence of end-organ damage: chest pain, dyspnea, neurologic deficit, visual change, or altered consciousness.
• D. ✅ CORRECT — 180/110 is Stage 2 hypertension approaching the severe range. With no symptoms this is asymptomatic severe hypertension ('hypertensive urgency'), not an emergency. ELECTIVE dental care is DEFERRED and the patient is referred for medical evaluation, usually within days.

Note: Repeat the measurement after 5 minutes of rest to confirm; if confirmed and asymptomatic → defer and refer. Symptoms present → emergency.