Medical Emergencies · single question
A patient with hypertension takes lisinopril and needs an extraction. After administration of local anesthesia, blood pressure rises to 150/95 mmHg. Which of the following is the most appropriate action?
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Correct answer: D. No modification needed — proceed with treatment
- A. Dentists should NOT administer additional doses of a patient's antihypertensive medication in-office. Dosing changes are the physician's decision.
- B. Cancellation would be appropriate only for BP ≥180/120 with symptoms (hypertensive urgency/emergency) or if the patient is symptomatic.
- C. Sublingual nifedipine is contraindicated — it can cause precipitous BP drop, reflex tachycardia, and myocardial ischemia. Its use was abandoned decades ago.
- D. CORRECT — 150/95 mmHg is Stage 2 hypertension by AHA/ACC criteria but is not a hypertensive urgency (≥180/120). Transient rises after local anesthesia (especially with epinephrine) are common in anxious/HTN patients. If the patient is asymptomatic, you can proceed with routine dental treatment with monitoring.
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