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Hypertension Pre-Op BP Decision — ORE Part 1 MCQ

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ModerateHuman Disease & Dental ManagementHypertension Pre-Op BP DecisionORE Part 1

A 55-year-old patient with controlled hypertension requires extraction of the upper left second molar. They have no chest pain, breathlessness, neurological symptoms or visual disturbance. After a 5-minute rest, the repeat pre-operative blood pressure is 165/98 mmHg. What is the most appropriate action?

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

Reveal the answer and explanation

Correct answer: E — Proceed with extraction using local anaesthesia, stress-reduction measures and observation

Explanation lettering: D = shown as A · E = shown as D · A = shown as E

A is correct. The repeat pressure of 165/98 mmHg is elevated but below NICE’s severe-hypertension threshold of 180/120 mmHg. In this asymptomatic patient with established, controlled hypertension, extraction can proceed using routine measures to minimise anxiety and pain, with appropriate clinical observation. A single raised dental-clinic measurement should not prompt the dentist to prescribe or acutely adjust antihypertensive medication. B is inappropriate because same-day specialist assessment is reserved for severe hypertension with features such as retinal changes or life-threatening symptoms. C is disproportionate: general anaesthesia is not a treatment for a moderately raised blood pressure. D is outside the dentist’s role in this context and risks inappropriate acute BP reduction. E leaves necessary dental care untreated without clinical justification.

Reference: National Institute for Health and Care Excellence. Hypertension in adults: diagnosis and management (NG136), recommendations 1.2.2, 1.5.1 and 1.5.2; updated 26 February 2026. https://www.nice.org.uk/guidance/ng136/chapter/recommendations