Key messages:
- Periodontitis is linked to higher blood pressure in otherwise healthy individuals.
- Individuals with periodontitis had higher mean systolic and diastolic blood pressure and higher odds of systolic blood pressure ≥140 mm Hg.
- Gingival bleeding associated with higher mean systolic blood pressure.
- Undetected hypertension was a common finding among the participants.
- Promoting good oral health could help reduce periodontal disease and the risk of hypertension and its complications.
Introduction
Hypertension significantly increases the risk of complications associated with cardiovascular diseases. More than 30% of the general population have hypertension, and this percentage increases with age. Many individuals diagnosed with hypertension do not achieve optimal blood pressure control, even while using medications. Moreover, a considerable number of people remain unaware they have hypertension. Inflammation is recognized as a key factor in causing vascular dysfunction and plays a role in the development and progression of hypertension.
Periodontitis is a chronic inflammatory disease characterized by a dysregulated host inflammatory response to dysbiotic oral biofilm that, if not effectively treated, can cause progressive destruction of the tooth-supporting tissues and eventual tooth loss. Approximately 750 million people globally present with moderate to severe symptoms of periodontitis. Recent evidence suggests a possible causal link between periodontitis and hypertension. However, limited data are available on the nature of the association.
Objectives
This study investigated the relationship between periodontitis and arterial blood pressure in a sample of otherwise systemically healthy individuals. The prevalence of undiagnosed hypertension was also explored.
Methods
A case-control study including 250 participants with generalized severe periodontitis (cases) and 250 participants without periodontitis (controls) was designed from a register of clinical trials conducted between 2000 and 2018 in a university setting.
Linear, logistic regression, and mediation models tested the association between various periodontal measures and arterial blood pressure. The role of systemic inflammation was assessed by high-sensitivity C-reactive protein (hs-CRP) and white blood cell counts. Total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), glucose, and triglycerides were also assessed.
Results
The results of this study showed systemically healthy individuals with periodontitis had higher mean systolic and diastolic blood pressure than participants without periodontitis. Participants with periodontitis were more than twice as likely to have systolic blood pressure ≥140 mm Hg and almost 50% higher odds of diastolic blood pressure ≥80 mm Hg than those without periodontitis. Additionally, up to 45% of participants had undetected hypertension, with approximately 55% of these having periodontitis. Participants with periodontitis exhibited increased glucose, LDL, hsCRP and white blood cell levels and lower HDL levels compared to those without periodontitis.
Conclusions
Periodontitis is associated with higher systolic blood pressure in individuals who are otherwise healthy. Oral health professionals could play a crucial role in assisting in the screening and management of hypertension. Promoting periodontal and systemic health in oral health and medical settings may help reduce the burden of hypertension and its complications.
