Periodontal bacteria and hypertension: the oral infections and vascular disease epidemiology study (INVEST)

J Hypertens. 2010 Jul;28(7):1413-21. doi: 10.1097/HJH.0b013e328338cd36.


Objective: Chronic infections, including periodontal infections, may predispose to cardiovascular disease. We investigated the relationship between periodontal microbiota and hypertension.

Methods and results: Six hundred and fifty-three dentate men and women with no history of stroke or myocardial infarction were enrolled in INVEST. We collected 4533 subgingival plaque samples (average of seven samples per participant). These were quantitatively assessed for 11 periodontal bacteria using DNA-DNA checkerboard hybridization. Cardiovascular risk factor measurements were obtained. Blood pressure and hypertension (SBP > or =140 mmHg, DBP > or =90 mmHg or taking antihypertensive medication, or self-reported history) were each regressed on the level of bacteria: considered causative of periodontal disease (etiologic bacterial burden); associated with periodontal disease (putative bacterial burden); and associated with periodontal health (health-associated bacterial burden). All analyses were adjusted for age, race/ethnicity, sex, education, BMI, smoking, diabetes, low-density lipoprotein and high-density lipoprotein cholesterol. Etiologic bacterial burden was positively associated with both blood pressure and prevalent hypertension. Comparing the highest and lowest tertiles of etiologic bacterial burden, SBP was 9 mmHg higher, DBP was 5 mmHg higher (P for linear trend was less than 0.001 in each case), and the odds ratio for prevalent hypertension was 3.05 (95% confidence interval 1.60-5.82) after multivariable adjustment.

Conclusion: Our data provide evidence of a direct relationship between the levels of subgingival periodontal bacteria and both SBP and DBP as well as hypertension prevalence.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Antihypertensive Agents / therapeutic use
  • Blood Pressure
  • Cardiovascular Diseases / complications
  • Cardiovascular Diseases / drug therapy
  • Cardiovascular Diseases / etiology
  • Cohort Studies
  • Dental Plaque / complications
  • Dental Plaque / drug therapy
  • Dental Plaque / microbiology
  • Diabetes Mellitus / drug therapy
  • Female
  • Humans
  • Hypertension / blood
  • Hypertension / complications*
  • Hypertension / drug therapy
  • Male
  • Periodontal Diseases / complications*
  • Periodontal Diseases / drug therapy
  • Periodontal Diseases / microbiology
  • Prevalence
  • Prospective Studies
  • Risk


  • Antihypertensive Agents