A systematic review of cardiovascular effects of epinephrine on hypertensive dental patients

Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002 Jun;93(6):647-53. doi: 10.1067/moe.2002.123866.


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.

Study design: 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.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Anesthetics, Local / adverse effects
  • Blood Pressure / drug effects
  • Dental Care for Chronically Ill*
  • Dental Impression Technique / adverse effects
  • Dental Impression Technique / instrumentation
  • Epinephrine / adverse effects*
  • Heart Rate / drug effects
  • Humans
  • Hypertension*
  • Vasoconstrictor Agents / adverse effects*


  • Anesthetics, Local
  • Vasoconstrictor Agents
  • Epinephrine