An 18-year-old with no medical history and no medications presents in dental pain. Blood pressure is 180/100 mm Hg and he is otherwise asymptomatic. What is the most appropriate action?

Correct answer: B. Rest the patient and recheck the blood pressure after several minutes

• A. Emergency referral is reserved for a HYPERTENSIVE EMERGENCY — severe elevation WITH evidence of acute target-organ damage (chest pain, dyspnea, neurologic deficit, visual change). This patient is asymptomatic.
• B. CORRECT. A single elevated reading in an anxious patient IN PAIN is very often transient. Repeat the measurement after 5 minutes of quiet rest, on the correct arm with an appropriately sized cuff. Pain and anxiety are potent, reversible drivers of blood pressure, and treating the dental pain frequently lowers it. If it stays at this level, defer elective care and arrange medical follow-up.
• C. Prescribing without addressing either the source of pain or the blood pressure abandons both problems and misses an important screening opportunity.
• D. Ignoring a reading of 180/100 is unacceptable — even without symptoms it warrants confirmation and medical referral.