Osseointegrated dental implants were introduced in Japan in 1983, and the procedures are now performed very frequently. Dental implants are placed in a wide age range of patients, including elderly patients with hypertension. Patients with very high blood pressure are at great risk for acute medical problems when undergoing stressful dental procedures, such as oral surgery, periodontal surgery, and placement of dental implants [1].

Patients with normal blood pressure (<120/80 mmHg), prehypertension (120 to 139/80 to 89 mmHg), or stage I hypertension (140 to 159/90 to 99 mmHg) may receive regular dental care, but those with stage 2 hypertension (≥160/≥100 mmHg) should receive noninvasive treatment only and be referred to the physician for immediate follow-up [2]. Normotensive individuals may develop signs of hypertensive encephalopathy at blood pressures as low as 160/100 mmHg, whereas chronically hypertensive patients can tolerate higher blood pressure and may not do so until the blood pressure rises to 220/110 mmHg or above [3]. Although no recommendation has been presented on the optimal level of blood pressure to avoid hypertensive complications during invasive dental treatments, blood pressure in hypertensive patients should be maintained below 160/100 mmHg.

Pain, stress, or anxiety-related dental procedures can raise blood pressure in both hypertensive and normotensive patients [4]. We have employed intravenous sedation to manage patients with hypertension as well as dental anxiety and phobia. The oral antihypertensive agent nifedipine is mainly administered to patients with high systolic blood pressure (SBP) ≥160 mmHg prior to implant placement. To examine the effects of intravenous sedation and oral nifedipine on blood pressure and pulse rate in patients with perioperative high blood pressure, the clinical records of dental implant patients managed by intravenous sedation at our outpatient dental offices were retrospectively evaluated. The purpose of this clinical study is to examine whether intravenous sedation and oral administration of nifedipine is efficient for the hemodynamic for the patient with hypertension. The authors expect that it is possible not only to obtain a hemodynamic blood stable but also to prevent the medical sequelae by performing intravenous sedation and oral nifedipine for patients with hypertension.