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  • Systolic:    90 - 120 mm Hg

  • Diastolic:   80 - 89 mm Hg

Blood Pressure - Adult

Normal findings

Below normal findings

Above normal findings 

  • Systolic > 140 mm Hg OR Diastolic > 90 mm Hg

  • Causes

    • Hypertension

    • Pain

    • Stress

    • Medications

References

Dental Management of the Medically Compromised Patient. Little, Falace, Miller, Rhodus.  8th Edition

Patient Assessment Tutorials.  Nield-Gehrig, Willmann.  3rd Edition

Errors that can cause inaccurate blood pressure measurement

  • Causes of inaccurate HIGH reading

    • Lack of back support

    • Patient talking during measurement

    • Feet unsupported/dangling

    • Legs crossed

    • Arm positioned below the heart

    • Arm not adequately supported

    • Bladder too small for arm

    • Cuff wrapped too loosely

    • Full bladder

    • Patient not relaxed before taking the measurement

  • Causes of inaccurate LOW reading

    • Patient lying down

    • Bladder too large for arm

    • Not taking the patient's palpatory blood pressure first  - inflation level too low

    • Cuff pressure released too fast

    • Arm positioned above the heart

Management of abnormalities

  • Wait ten minutes and RETAKE the blood pressure

  • Ask an instructor to take the blood pressure

  • Is the patient aware of this condition?

  • Did the patient take his/her medication that day?

  • Is the patient anxious or fearful?

  • Is the patient in pain due to an oral/dental problem?

  • Systolic < 90 mm Hg OR Diastolic < 60 mm Hg

  • Causes

    • Normal variation - ask the patient!  

    • Medication

    • Heart failure

    • Dehydration

    • Adrenal hypofunction

Errors that can cause difficulty hearing the blood pressure

  • Amplifying device (diaphragm) not "turned on"

  • Earpieces not pointed slightly forward to match the path of the ear canal

  • Trying to take BP over thick clothing

  • Diaphragm not over brachial artery

  • Diaphragm not applied firmly

  • Diaphragm touching the tubes or cuff

Additional Management Considerations

  • Anesthesia:  Cardiac dose of epinephrine may be used in patients with blood pressure less than 180/110.  In patients with blood pressure higher than 180/110 (either systolic or diastolic), epinephrine can be used if the proposed benefits of its use outweigh potential risks, after consultation with physician.  Levonordefrin is contraindicated.

  • Anxiety:  Stress reduction protocols are especially important when a patient has hypertension and is fearful.

  • Bleeding:  Excessive bleeding due to severe hypertension is possible but unlikely.

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