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also be identified by the medicines the patient reports taking. (Some patients with controlled hypertension, reasoning they are normotensive with treatment, do not indicate they have high bloodpressure.) Medical diseases that are causative for secondary hypertension or increased cardiovascular risk should also be considered in evaluating the patient for hypertension. Consultation with thephysician should be sought whenever the dentist needs clarification about the patient’s physical status and/or ability to tolerate stress.

Dental patients with hypertension are also often identified bymeasurement of their blood pressure. Recording of a blood pressure in excess of 39 mm Hg systolic or 89 mm Hg diastolic in the dental office does not automatically mean the patient is hypertensive.The blood pressure recording may be elevated for technical reasons, which is discussed later, or because the patient is fearful or otherwise emotionally stressed in the dental office. Physician referralfor all patients with high blood pressure in the dental office is necessary to help ensure they have the opportunity get their blood pressure under control if it is truly high. The actual diagnosisof hypertension will be made by the physician, often after multiple blood pressures have been measured over several weeks to months. Patients who suffer from white coat syndrome, a condition in whichtheir blood pressures are consistently increased in the medical or dental office but not elsewhere, may have to keep a log of blood pressures taken during the course of daily life for an accuratediagnosis to be made.23
In general, the dentist should consider the severity of high blood pressure and the existence of other cardiovascular risk factors in making treatment decisions. Although Stage hypertension poses serious cumulative danger to the patient over the course of years to decades, it is usually of little immediate consequence, and regular dental care is appropriate, with the...