Abstract
Arterial hypertension is a chronic cardiovascular disease with a high global prevalence and represents a public health issue in Uruguay. The use of vasoconstrictors in hypertensive patients remains a debated topic in dentistry due to concerns regarding their safety. Objectives: This review evaluates the impact of using local anesthetics with vasoconstrictors in hypertensive patients, analyzing potential adverse effects and factors influencing the safety and effectiveness of dental treatment. Methodology: A literature review was conducted by consulting databases such as PubMed, SciELO, BVS-Odontología (UdelaR), and Google Scholar. The search covered publications from 2014 to October 2024 in English, Spanish, and Portuguese. After applying selection criteria, 25 bibliographic sources were included in this article. Results: The most commonly used vasoconstrictor is epinephrine, with a maximum recommended dose of
0.04 mg for hypertensive patients to minimize associated risks and ensure safer administration. The findings highlight the importance of a thorough cardiovascular assessment before its use. Conclusions: Available evidence suggests that the use of local anesthetics with epinephrine concentrations up to 0.04mg would be justified in patients with controlled hypertension classified as ASA II. Further clinical and laboratory studies are necessary to strengthen and confirm the presented evidence.
References
Calistro LC, Tinoco EJF, Alcolumbre SB, Paraguassu EC, Voss D. Dental care in hypertensive patients: systematic review. Braz J Implantol Health Sci. 2019 Nov 26;1(6):152–68.
Seminario-Amez M, González-Navarro B, Ayuso-Montero R, Jané-Salas E, López-López J. Uso de anestésicos locales con un agente vasoconstrictor durante el tratamiento dental en pacientes hipertensos y con enfermedad coronaria: una revisión sistemática. J Evid Based Dent Pract. 2021 Jun 1;21(2):101569.
Cruz-Aranda JE. Manejo de la hipertensión arterial en el adulto mayor. Med Int Mex. 2019 Aug 1;35(4):515–24.
Chávez Guimaraes C, Lopes LC, Bergamaschi C de C, Ramacciato JC, Silva MT, Araújo J de O, Andrade NK, López Motta RH. Anestésicos locales combinados con vasoconstrictores en pacientes con enfermedades cardiovasculares sometidos a procedimientos dentales: revisión sistemática y meta-análisis. BMJ Open. 2021 Jul;11(7):e044357.
Al Ghorani H, Götzinger F, Böhm M, Mahfoud F. Hipertensión arterial: actualización de ensayos clínicos 2021. Nutr Metab Cardiovasc Dis. 2021 Sep;32(1):1–10.
Nascimento ES do, Araújo R de S, Lima AJO, Gonçalves VLR, Jardim A de A, Sousa LL de, Carvalho RF. Cuidados odontológicos en pacientes hipertensos: revisión integrativa de literatura. Braz J Health Rev. 2023 Apr 10;6(2):7341–52.
Ministerio de Salud Pública. Día Mundial de la Hipertensión: mida su presión arterial con precisión, contrólela y ¡viva más tiempo!. Available from: https:// www.msp.gub.uy
Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC Jr, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA Sr, Williamson JD, Wright JT Jr. 2017 ACC/AHA/AAPA/ ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018 May 15;71(19):e127–e248.
Mundiya J, Woodbine E. Updates on topical and local anesthesia agents. Oral Maxillofac Surg Clin North Am. 2021 Oct;33(4):1–10.
Quiñónez Arroyo FC. Anestésicos locales en pacientes hipertensos en odontología. Repositorio San Gregorio Edu. 2021. Available from: https:// repositorio.sangregorio.edu.ec
Helena J, Rabelo R. Cuidados com o paciente hipertenso no atendimento odontológico: revisão de literatura. São Luís. 2021.
Calderón MM, Cruz Chavarrea LC. Manejo odontológico de anestésicos locales en pacientes hipertensos. Unach Eduec. 2021
Scully C. Scully's handbook of medical problems in dentistry. 1st ed. Edinburgh: Elsevier; 2016.
Malamed SF. Manual de anestesia local. 6th ed. España: Elsevier; 2015.
Essado AG. Uso de mepivacaína 2% associada à epinefrina em pacientes hipertensos durante tratamento odontológico. Uberaba, MG. 2019.
Southerland J, Gill D, Gangula P, Halpern L, Cardona CY, Mouton C. Dental management in patients with hypertension: challenges and solutions. Clin Cosmet Investig Dent. 2016 Oct;8:111–20.
Marinkovic D, Fuentes V, Azócar D, Vargas JP, Verdugo MF, Pinedo F, et al. Local anaesthetics combined with vasoconstrictors in controlled hypertensive patients undergoing dental procedures: systematic review and meta-analysis. Int J Odontostomatol. 2023, 17(2):206–15.
Mathison M, Pepper T. Local anesthesia techniques in dentistry and oral surgery. Treasure Island (FL): StatPearls Publishing; 2024.
Gupta K, Kumar S, Anand Kukkamalla M, Taneja V, Syed GA, Pullishery F, et al. Dental management considerations for patients with cardiovascular disease: a narrative review. Rev Cardiovasc Med. 2022 Jul 20;23(8):261–9.
Luo W, Zheng K, Kuang H, Li Z, Wang J, Mei J. The potential of articaine as a new generation of local anesthesia in dental clinics: a review. Medicine (Baltimore). 2022 Dec 2;101(48):e32089.
Manríquez Ávila A, Lucía M, Daniel C, Alfonso. Efectos hemodinámicos del uso de articaína con epinefrina en pacientes hipertensos y no hipertensos sometidos a cirugía oral. Nova Sci. 2015;7(14):254–67.
Francisco E, Leite TR, Silva L. Cirurgia odontológica em pacientes hipertensos: revisão de literatura. Facit Bus Technol J. 2022; 2(36).
Castellanos L, Armando E, María L. Medicina en odontología: manejo dental de pacientes con enfermedades sistémicas. 3rd ed. México D.F.: Editorial El Manual Moderno; 2015.
Silvestre F, Martinez-Herrera M, García-López B, Silvestre-Rangil J. Influence of anxiety and anesthetic vasoconstrictor upon hemodynamic parameters during dental procedures in controlled hypertensive and non-hypertensive patients. J Clin Exp Dent. 2021;13(2):e156–64.
Boff E, Palma LZ. Avaliação da pressão arterial no atendimento odontológico como forma de busca ativa de novos casos de hipertensão arterial sistêmica. Unijui.edu.br; 2024.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright (c) 2026 Manuela Acosta, Yoana Pregliasco, Lauren Frenzel Schuch, Vanesa Pereira Prado