Association between periodontal inflammation and hypertension using periodontal inflamed surface area and bleeding on probing

Abstract

Aim Periodontitis is a relapsing–remitting disease. Compared with bleeding on probing (BoP), expression of disease activity, periodontal inflamed surface area (PISA), incorporates chronic disease parameters. We tested the association of PISA and BoP with blood pressure (BP) in NHANES III. Materials and methods A total of 8,614 subjects (≥30 years) with complete periodontal and BP examinations were enrolled. PISA was derived from periodontal probing depth and BoP. The association of PISA and BoP with high/uncontrolled BP was examined by multiple‐adjusted models. Inflammatory markers were tested as possible mediators. A machine learning (ML) approach was used to define the relative importance of PISA and BoP and estimate the power of BP status prediction. Results Compared to no inflammation, severe PISA and BoP were associated with 43% (p < .001) and 32% (p = .006) higher odds of high/uncontrolled BP (≥130/80 mmHg), and with higher systolic BP by ≈4 (p < .001) and 5 (p < .001) mmHg, respectively. Inflammatory markers appeared to mediate this association with various extents, without threshold effect. BoP predicted high/uncontrolled BP more efficiently than PISA using ML. Conclusion PISA and BoP describe the association of periodontal inflammation and hypertension with subtle differences. The contribution of local inflammation to the global inflammatory burden might explain the observed findings.

Association between Periodontitis and High Blood Pressure: Results from the Study of Periodontal Health in Almada-Seixal (SoPHiAS)

“…Still, our data raise the hypothesis of a possible linear relationship between different measurements of gingival health and BP measurements. Indeed, a linear association between gingival bleeding on probing and SBP and DBP were observed, similarly to previous evidence [18,22,45,46]. In other words, the more severe the periodontitis, the higher the mean BP.…”

“…Several lines of evidence suggest that periodontitis is associated with an increased risk of high BP [18,22,43,45,46]. Still, our data raise the hypothesis of a possible linear relationship between different measurements of gingival health and BP measurements.…”

Is systemic inflammation a missing link between periodontitis and hypertension? Results from two large population‐based surveys

“…In the mediation analysis, our findings suggest that CRP and WBC mediate partly the association between periodontitis and hypertension, although the effect is rather modest in nature (only 2% of the association explained by the model for the Korean survey whilst up to 7% in the US survey). Similar findings were recently reported for CRP (5.4%), WBC (4.2%) and ferritin (10.2%) as mediators of the total association between a continuous measure of periodontitis and high/uncontrolled BP (≥130/80 mmHg) [36]. An alternative pathway implicated in hypertension and cardiovascular injury relates to the activation of innate and adaptive immune cells such as monocyte/macrophages, and B and T lymphocytes [37].…”

“…(≥130/80 mmHg) [36]. An alternative pathway implicated in hypertension and cardiovascular injury relates to the activation of innate and adaptive immune cells such as monocyte/macrophages, and B and T lymphocytes [37].…”

Periodontitis, Blood Pressure, and the Risk and Control of Arterial Hypertension: Epidemiological, Clinical, and Pathophysiological Aspects—Review of the Literature and Clinical Trials

“…Compared to the absence of inflammation, severe PISA and BoP were associated with 43% ( p <0.001) and 32% ( p = 0.006) more likely to have high/uncontrolled BP (≥130 / 80 mmHg) and a higher systolic blood pressure by ≈4 ( p <0.001) and 5 ( p <0.001) mmHg. Thus, a significant relationship has been demonstrated between periodontitis and the risk of arterial hypertension [ 27 ••].…”