Poor Oral Health and BP Control Among US Hypertensives

Study Questions:

Periodontal disease is a chronic inflammatory disorder of the tissues surrounding the teeth. Some studies have shown a benefit of periodontal therapy for reducing cardiovascular risk factors. Is there an impact of periodontitis on blood pressure (BP) control?

Methods:

The authors retrospectively analyzed cross-sectional, nationally representative data (National Health and Nutrition Examination Survey [NHANES] 2009-2014) from treated hypertensive adults aged ≥30 years with and without periodontitis. BP was examined as both continuous (mm Hg) and categorical (guideline achievement status) variable according to the presence or absence of periodontitis and its clinical parameters (probing depth, clinical attachment loss, and disease severity [mild, moderate, and severe]). Systolic BP (sBP) means and odds ratios for uncontrolled BP according to the presence and severity of periodontitis were calculated using progressively adjusted models.

Results:

A total of 11,753 participants underwent periodontal exams, of whom about 3,500 reported taking medication for hypertension; 47.8% were free of periodontal disease. Among those, 52% had periodontal disease, 38% were moderate, 12% severe, and 3% mild. Mean sBP among untreated hypertensives was about 2.8-7.6 mm Hg higher in patients with periodontitis, and among treated hypertensive adults, mean sBP was about 2.3-3 mm Hg higher in the presence of periodontitis (p < 0.0001). Periodontitis was associated with unsuccessful antihypertensive treatment after multiple adjustments, with higher odds by disease severity. Good periodontal health is associated with better sBP profile during antihypertensive therapy by about 2.3-3 mm Hg, and with lower odds of antihypertensive treatment failure.

Conclusions:

Dedicated studies are needed to test the impact of periodontal therapy on BP and the long-term effects on cardiovascular outcomes of this complementary approach to systemic health.

Perspective:

Many cardiovascular risk factors and cardiovascular events have been associated with periodontitis with posits including increased systemic inflammation and evidence of anaerobic bacterial remnants within the vascular wall and plaque. There are reports that periodontal therapy improves vascular endothelial function, which infers it may help lower blood pressure.

Clinical Topics: Diabetes and Cardiometabolic Disease, Prevention, Hypertension

Keywords: Antihypertensive Agents, Blood Pressure, Cardiovascular Diseases, Hypertension, Hypotension, Inflammation, Metabolic Syndrome X, Oral Health, Periodontal Diseases, Periodontitis, Periodontics, Primary Prevention, Risk Factors, Treatment Failure


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