Recent evidence suggests a link between periodontitis (PD) and hypertension, but the nature of this association remains unclear. The overall aim of this review was to critically appraise the evidence linking these two common disorders. Systematic search was conducted for studies published up to December 2018. Prevalence of hypertension in patients with PD (moderate/severe groups) vs. those without PD (non-PD) was the primary outcome. Additional outcomes included adjusted mean difference in systolic (SBP) and diastolic (DBP) blood pressure (BP) levels in PD vs. non-PD, assessment of biomarkers in PD and hypertension, and BP changes after periodontal therapy. From 81 studies selected, 40 were included in quantitative meta-analyses. Diagnoses of moderate-severe PD [odds ratio (OR) = 1.22; 95% confidence interval (CI): 1.10-1.35] and severe PD (OR = 1.49; 95% CI: 1.09-2.05) were associated with hypertension. Prospective studies confirmed PD diagnosis increased likelihood of hypertension occurrence (OR = 1.68; 95% CI: 0.85-3.35). Patients with PD exhibited higher mean SBP [weighted mean difference (WMD) of 4.49 mmHg; 95% CI: 2.88-6.11] and DBP (2.03 mmHg; 95% CI: 1.25-2.81) when compared with non-PD. Lastly, only 5 out of 12 interventional studies confirmed a reduction in BP following periodontal therapy, ranging from 3 to 12.5 mmHg of SBP and from 0 to 10 mmHg of DBP. PD is associated with increased odds of hypertension (SORT C) and higher SBP/DBP levels. The evidence suggesting that PD therapy could reduce BP is inconclusive. Although additional research is warranted on this association, these results suggest that oral health assessment and management of PD could not only improve oral/overall health and quality of life but also be of relevance in the management of patients with hypertension.
Keywords: Periodontal therapy; Blood pressure; Hypertension; Inflammation; Oral health; Periodontal diseases; Periodontitis.
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: email@example.com.
Blood Pressure Targets for Hypertension in People With Diabetes MellitusJA Arguedas et al. Cochrane Database Syst Rev (10), CD008277. PMID 24170669. - ReviewAt the present time, evidence from randomized trials does not support blood pressure targets lower than the standard targets in people with elevated blood pressure and di …
Effects of Low Sodium Diet Versus High Sodium Diet on Blood Pressure, Renin, Aldosterone, Catecholamines, Cholesterol, and TriglycerideNA Graudal et al. Cochrane Database Syst Rev 4 (4), CD004022. PMID 28391629. - ReviewSodium reduction from an average high usual sodium intake level (201 mmol/day) to an average level of 66 mmol/day, which is below the recommended upper level of 100 mmol/ …
Effects of Flaxseed Supplements on Blood Pressure: A Systematic Review and Meta-Analysis of Controlled Clinical TrialS Ursoniu et al. Clin Nutr 35 (3), 615-25. PMID 26071633. - ReviewThis meta-analysis of RCTs showed significant reductions in both SBP and DBP following supplementation with various flaxseed products.
Effects of Blood Pressure Lowering on Outcome Incidence in Hypertension: 2. Effects at Different Baseline and Achieved Blood Pressure Levels--Overview and Meta-Analyses of Randomized TrialsC Thomopoulos et al. J Hypertens 32 (12), 2296-304. PMID 25259547. - ReviewMeta-analyses favor BP-lowering treatment even in grade 1 hypertension at low-to-moderate risk, and lowering SBP/DBP to less than 140/90 mmHg. Achieving less than 130/80 …
Combined Calcium, Magnesium and Potassium Supplementation for the Management of Primary Hypertension in AdultsFR Beyer et al. Cochrane Database Syst Rev (3), CD004805. PMID 16856060. - ReviewWe found no robust evidence that supplements of any combination of potassium, magnesium or calcium reduce mortality, morbidity or BP in adults. More trials are needed to …
Cited by 2 PubMed Central articles
Periodontal Therapy for Primary or Secondary Prevention of Cardiovascular Disease in People With PeriodontitisW Liu et al. Cochrane Database Syst Rev 12 (12), CD009197. PMID 31887786. - ReviewFor primary prevention of cardiovascular disease (CVD) in people diagnosed with periodontitis and metabolic syndrome, very low-certainty evidence was inconclusive about t …
Causal Association Between Periodontitis and Hypertension: Evidence From Mendelian Randomization and a Randomized Controlled Trial of Non-Surgical Periodontal TherapyM Czesnikiewicz-Guzik et al. Eur Heart J 40 (42), 3459-3470. PMID 31504461.A causal relationship between periodontitis and BP was observed providing proof of concept for development of clinical trial in a large cohort of hypertensive patients. C …