Adrenaline in Hypertension — ORE Part 1 MCQ

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EasyPharmacology & TherapeuticsAdrenaline in HypertensionORE Part 1

A patient has well-controlled hypertension and takes ramipril 10 mg once daily. An inferior alveolar nerve block is required. Which is the most appropriate approach to local anaesthesia?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Use lidocaine with adrenaline in the usual dental dose

Explanation lettering: D = shown as B · B = shown as D

The best answer is A. In a patient with controlled hypertension, adrenaline-containing lidocaine is not absolutely contraindicated. The UK SmPC advises caution in hypertension, so routine safe local-anaesthetic technique is important: use the lowest effective dose, aspirate and inject slowly to avoid intravascular administration. Ramipril does not require omission before routine dental local anaesthesia. B is wrong because hypertension is not listed as a contraindication. C gives an arbitrary blood-pressure threshold; controlled hypertension need not be below 120/80 mmHg. D is inappropriate because stopping antihypertensive treatment may worsen blood-pressure control. E is wrong because felypressin is not universally safer and is not required solely because hypertension is controlled.

Reference: Electronic Medicines Compendium. Lidocaine 2% with adrenaline (epinephrine) 1:200,000 solution for injection: Summary of Product Characteristics, sections 4.2-4.5, updated 7 May 2023. https://www.medicines.org.uk/emc/product/2396/smpc