Patients with periodontitis have a greater likelihood for hypertension, according to researchers at the University College London Eastman Dental Institute.
“We observed a linear association. The more severe periodontitis is, the higher the probability of hypertension,” said senior author and professor of periodontology Francesco D’Aiuto, DMD, MClinDent, PhD.
“The findings suggest that patients with gum disease should be informed of their risk and given advice on lifestyle changes to prevent high blood pressure such as exercise and a healthy diet,” said D’Aiuto.
High blood pressure affects 30% to 45% of adults and is the leading cause of premature death, the researchers report, while periodontitis affects more than 50% of the world’s population. Hypertension also is the main preventable cause of cardiovascular disease, and periodontitis has been linked with increased risk of heart attack and stroke.
“Hypertension could be the driver of heart attack and stroke in patients with periodontitis,” said D’Aiuto. “Previous research suggests a connection between periodontitis and hypertension and that dental treatment might improve blood pressure, but to date the findings are inconclusive.”
The researchers say that they compiled the best available evidence to examine the odds of high blood pressure in patients with moderate and severe gum disease, including 81 studies from 26 countries in their meta-analysis.
Moderate to severe periodontitis was associated with a 22% raised risk for hypertension, while severe periodontitis was linked with 49% higher odds of hypertension.
“We observed a positive linear relationship with the hazard of high blood pressure rising as gum disease became more severe,” said lead author and professor of periodontology Eva Munoz Aguilera, MClindDent.
Average arterial blood pressure was higher in patients with periodontitis compared to those without, amounting to 4.5 mmHg higher systolic and 2 mmHg higher diastolic blood pressures.
“The differences are not negligible,” said Aguilera. “An average 5 mmHg blood pressure rise would be linked to a 25% increased risk of death from heart attack or stroke.”
Just five of 12 interventional studies included in the review showed a reduction in blood pressure following gum treatment. The changes occurred even in people with healthy blood pressure levels.
“There seems to be a continuum between oral health and blood pressure which exists in healthy and diseased states,” said D’Aiuto.
“The evidence suggesting periodontal therapy could reduce blood pressure remains inconclusive. In nearly all intervention studies, blood pressure was not the primary outcome. Randomized trials are needed to determine the impact of periodontal therapy on blood pressure,” D’Aiuto said.
When it comes to the connections between the conditions, gum disease and its associated oral bacterial lead to inflammation throughout the body, which affects blood vessel function. Common genetic susceptibility also could play a role, along with shared risk factors such as smoking and obesity.
“In many countries throughout the world, oral health is not checked regularly, and gum disease remains untreated for many years. The hypothesis is that this situation of oral and systemic inflammation and response to bacteria accumulates on top of existing risk factors,” D’Aiuto said.
D’Aiuto also noted that while the study investigated gum disease as a potential risk factor for hypertension, the reverse also could be true.
“Further research is needed to examine whether patients with high blood pressure have a raised likelihood of gum disease. It seems prudent to provide oral health advice to those with hypertension,” D’Aiuto said.
The study, “Periodontitis Is Associated With Hypertension: A Systematic Review and Meta-Analysis,” was published by Cardiovascular Research.
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