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Periodontitis and Hypertension: A Meta-Analysis

2/4/2020 3:53:01 PM
arteryAlmost 45% of the worldwide population has hypertension. Hypertension remains poorly controlled in many patients, with high rates of no treatment or under-treatment. While endothelial dysfunction, oxidative stress, and inflammation are implicated in the pathogenesis of hypertension, not all of the involved mechanisms are clear.
Periodontitis is another extremely common condition, estimated to affect more than 50% of people worldwide. Periodontitis is an oral disease that is caused by dysbiotic microflora in the mouth that leads to the destruction of the gum tissue and eventual tooth loss. In many patients, periodontitis is accompanied by systemic inflammation and endothelial dysfunction. Observational studies suggest that periodontitis is associated with an increased risk for cardiovascular disease.

Review examines hypertension and periodontitis relationship

To more thoroughly evaluate the relationship between periodontitis and hypertension, researchers conducted a systematic review and meta-analysis. The primary outcome measure was the odds ratio (OR) for hypertension in individuals with periodontitis.
Twenty studies compared the odds of having hypertension in patients with periodontitis vs. healthy individuals. Results of the meta-analysis showed that patients with moderate-to-severe periodontitis have 22% greater odds of having hypertension (OR=1.22; 95% CI, 1.10-1.35) than people without periodontitis. The association was linear, such that those with severe periodontitis had an even higher likelihood (OR=1.45; 95% CI, 1.09-2.05) of having hypertension.

Results show connection between gum health and blood pressure

Some of the secondary outcomes of this meta-analysis were also interesting. More than 80% of the included studies that reported levels of blood pressure showed consistently increased levels of systolic and diastolic blood pressure in patients with periodontitis, with weighted mean differences of +4.49 mmHg for systolic and +2.03 mmHg for diastolic. Also, in 5 out of 12 interventional studies, the treatment of periodontal disease led to decreases in blood pressure.
The proposed mechanisms to explain how periodontitis might contribute to hypertension include systemic inflammation, immune responses to Porphyromonas gingivalis (a common periodontitis pathogen), and sympathetic nervous system activation. These mechanisms interact to lead to vascular and perivascular inflammation, endothelial dysfunction, and hypertension.
The authors of this study conclude that “periodontitis treatment could represent a novel non-pharmacological therapy to prevent or help manage hypertension.” They encourage clinicians to offer oral health advice to all patients with hypertension.    
Muñoz Aguilera E, Suvan J, Buti J et al. Periodontitis is associated with hypertension: a systematic review and meta-analysis. Cardiovasc Res. 2019;