Poor Oral Health and Blood Pressure Control Among US Hypertensive Adults

Abstract

Periodontal disease is a chronic inflammatory disorder of the tissues surrounding the teeth, with evidence of systemic effects. Some studies showed the benefit of periodontal therapy on blood pressure (BP), but the impact of periodontitis on BP control is unknown. We retrospectively analyzed cross-sectional, nationally representative data from treated hypertensive adults aged ≥30 years with and without periodontitis. BP was examined as both continuous (mm Hg) and categorical (treatment goal achievement status according to guidelines: at goal and above goal) 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 means and odds ratios for uncontrolled BP according to the presence and severity of periodontitis were calculated using progressively adjusted models. Among treated hypertensive adults, mean systolic BP was about 2.3 to 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. A good periodontal health is associated with better systolic BP profile during antihypertensive therapy by about 2.3 to 3 mm Hg and with lower odds of antihypertensive treatment failure. 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.

Definition of hypertension‐associated oral pathogens in NHANES

“…Therefore, systolic BP seems to confirm itself as the component that best discriminates the association between BP and periodontitis. 13 This study is not without limitations. First, the crosssectional nature of the survey does not allow any inference about a causal relationship in the observed findings; second, serum IgGs, and not the actual periodontal microbial composition, were available for the analyses, and whether antibodies levels are modulated by the phenomenon of inflammaging/immunosenescence, [43][44][45] that of cross-reactivity, or reflect other unmeasured clinical features with impact on BP or oral health, 32,46,47 cannot be excluded; third, the examined pathogens are only a minority of the oral microbiome, 28,42 and the impact of potentially related, yet unmeasured, species must be considered.…”

“…In particular, participants were stratified by categories of age (<45, 45 to 64, and ≥65 years), sex (men/women), race (non‐Hispanic whites; non‐Hispanic blacks; Mexican‐Americans; other Hispanics; other, including multiracial), ethnicity (Hispanics, including Mexican‐Americans and other Hispanics; non‐Hispanics, including whites, blacks, and multiracial), US region (northeast, midwest, south, west), urban code (central or rural area), body mass index (BMI), diabetes mellitus (yes/no), education (<high school; high school; >high school), income‐to‐poverty ratio, and smoking and alcohol use (current, past, never), as collected by NHANES. Ethnicity was examined in terms of being or not Hispanic, due to increased susceptibility of Hispanics to both high BP and periodontal disease . Indexes of periodontal health, namely bleeding on probing (BOP), clinical attachment loss (AL), and probing depth (PD) were obtained as described elsewhere .…”

“…12 In addition, we recently reported on an association between periodontal disease and hypertension, highlighting higher odds of antihypertensive treatment failure in patients with moderate/severe periodontitis. 13 Since antibodies against oral pathogens can be considered as a humoral, host-related phenotype of periodontal microbiota, 9 we hypothesized that there could be an association between the oral microbiota immunoglobulins and BP. We therefore aimed at assessing the antibodies to the oral microbiome that were associated with high BP, using data from the Third National Health and Nutrition Examination Survey (NHANES III).…”

The state of periodontum and cardiovascular risk factors in adolescents with high blood pressure

“…It has been mentioned above that the relationship between periodontal state and BP level was confirmed by a number of studies in the adult cohort [9,[20][21][22]. The number of works focused on studying this problem in young people and adolescents is quite limited.…”

“…This is especially important in the light of recently published results of the USA National Health and Nutrition Examination Survey (2009 -2014). It showed that the periodontitis in adult patients with hypertension is associated with a lack of effect from antihypertensive therapy; and, vice versa, good periodontal health is associated with the best systolic BP profile against the background treatment and with lower chances of its inefficiency [9].…”