Postural hypotension (Table 2) is defined as a decline of ≥20 mm Hg in the systolic BP, and/or a decline of ≥10 mm Hg in the diastolic BP, or an increase of ≥20 beats/minute in pulse rate, and abrupt symptoms of cerebral ischemia (syncope) following postural change from a supine to an upright position. It may be secondary to impaired homeostatic mechanisms of blood pressure regulation; age and/or cardiovascular-disease-related physiological changes; anti-hypertensive medications; and/or recent intake of food.
Table 2. Postural Hypotension.
Prevention:
Identify at-risk patient
Schedule dental appointments 30 to 60 minutes after the ingestion of meals and medications
Ensure profound local anesthesia
Use local anesthetic agents containing a vasoconstrictor congruent with the patient’s functional capacity
Upon completion of procedures, allow at-risk patients to assume an upright position gradually over 2 minutes
Signs and symptoms:
No prodromal signs and symptoms
Abrupt syncope when patient assumes an upright position
A decline (from baseline) of 20 mm Hg or more in the systolic blood pressure AND/OR
A decline (from baseline) of 10 mm Hg or more in the diastolic blood pressure AND/OR
An increase (from baseline) in pulse rate of 20 beats per minute or more
Emergency response:
Immediately return patient to supine position for 5-10 minutes
Administer oxygen
4 to 6 L/min by nasal cannula
Reevaluate vital signs
Allow patient to assume a sitting position for at least 2 minutes
Reevaluate vital signs
Allow patient to stand for 2 minutes
Reevaluate vital signs
If patient’s condition is deteriorating
Notify EMS
Monitor vital signs
If at any time the patient becomes unresponsive, no normal breathing, and no palpable pulse consider the diagnosis of cardiac arrest
Immediate CPR and defibrillation congruent with current recommendations
Nota bene:
Signs of recovery: vital signs return to baseline values, patient is alert
Signs of deterioration: vital signs unstable, mental status labile
Postural hypotension, often observed in older patients, may result in significant morbidity from associated falls
The lack of prodromal signs and symptoms should prompt oral healthcare providers to take preemptive action.
