title: A systematic review of cardiovascular effects of epinephrine on hypertensive dental patients.
abstract: OBJECTIVE
  A systematic review was conducted to identify any additional risks of adverse cardiovascular outcomes to hypertensive individuals represented by use of epinephrine-containing anesthetic solutions and epinephrine-impregnated retraction cords.
  
  
  METHODS
  Two searches identified 373 local anesthetic and 33 retraction cord reports; 6 local anesthetic reports met inclusion criteria.
  
  
  RESULTS
  Use of epinephrine in uncontrolled hypertensive patients was associated with small, nonsignificant increases in systolic and diastolic blood pressure. No adverse outcomes were reported. Only one study examined effects of epinephrine on controlled hypertensive patients, in whom additional risks due to interactions with antihypertensive medication are possible. Available studies did not address effects of gingival retraction cord on hypertensive patients.
  
  
  CONCLUSIONS
  Although the increased risk for adverse events among uncontrolled hypertensive patients was found to be low and the reported occurrence of adverse events in hypertensive patients associated with the use of epinephrine in local anesthetics was minimal, the quantity and quality of the pertinent literature is problematic.
authors.affiliation: School of Dentistry, Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC 27599, USA. jim_baderunc.edu
authors.forename: James D
authors.initials: JD
authors.lastname: Bader
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Bonito
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Shugars
mesh_terms: D000779:Anesthetics, Local / Q000009:adverse effects; D001794:Blood Pressure / Q000187:drug effects; D017742:Dental Care for Chronically Ill; D003761:Dental Impression Technique / Q000009:adverse effects / Q000295:instrumentation; D004837:Epinephrine / Q000009:adverse effects*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006973:Hypertension; D014662:Vasoconstrictor Agents / Q000009:adverse effects*
chemical_list: D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D004837:Epinephrine