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A new study compiling the best available evidence to examine the odds of high blood pressure in patients with moderate and severe gum disease has determined that people with gum disease – also known as periodontitis - have a greater likelihood of high blood pressure – also known as hypertension. "We observed a linear association -- the more severe periodontitis is, the higher the probability of hypertension,” says senior author Professor Francesco D'Aiuto of UCL Eastman Dental Institute, UK. 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."
Periodontitis affects more than 50 percent of the world's population and has been linked with increased risk of heart attack and stroke. High blood pressure affects 30 to 45 percent of adults, is the leading global cause of premature death, and is the main preventable cause of cardiovascular disease. "Hypertension could be the driver of heart attack and stroke in patients with periodontitis," Professor D'Aiuto continued. "Previous research suggests a connection between periodontitis and hypertension and that dental treatment might improve blood pressure, but to date the findings are inconclusive."
Eighty-one studies from 26 countries were included in the meta-analysis. Moderate-to-severe periodontitis was associated with a 22 percent raised risk for hypertension, while severe periodontitis was linked with 49 percent higher odds of hypertension. "We observed a positive linear relationship, with the hazard of high blood pressure rising as gum disease became more severe," added lead author Dr. Eva Munoz Aguilera of UCL Eastman Dental Institute. Average arterial blood pressure was higher in patients with periodontitis compared to those without. This amounted to 4.5 mmHg higher systolic and two mmHg higher diastolic blood pressures. "The differences are not negligible," said Dr. Munoz Aguilera. "An average five mmHg blood pressure rise would be linked to a 25 percent increased risk of death from heart attack or stroke."
Five out of 12 interventional studies included in the review - published in Cardiovascular Research, a journal of the European Society of Cardiology (ESC) - 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,” Professor D'Aiuto added. “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."
Regarding potential reasons for the connection between the conditions, gum disease and the associated oral bacteria lead to inflammation throughout the body, which affects blood vessel function. Common genetic susceptibility could also 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,” Professor D'Aiuto added. “The hypothesis is that this situation of oral and systemic inflammation and response to bacteria accumulates on top of existing risk factors." He noted that the study investigated gum disease as a potential risk factor for hypertension, but the reverse could also 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.”
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