Gum disease doubles the risk of high blood pressure
29 March 2021
Adults with periodontitis, a serious gum disease, may be twice as likely to have higher blood pressure compared to those with healthy gums, finds a new study led by UCL researchers.
Periodontitis is a severe infection of the gum tissues that can lead to chronic inflammation and destroy the bone that supports the teeth, leading to tooth loss.
The study, published in the journal Hypertension, found that 14% of people with periodontitis met the clinical threshold for hypertension (high blood pressure) in the UK, as opposed to 7% of a control group without periodontitis. The researchers also found that periodontitis was linked with higher blood pressure in otherwise healthy individuals.
Researchers say the findings show that consideration should now be given to dental health professionals carrying out high blood pressure screening, and referring affected patients to primary care doctors.
Lead author Dr Eva Muñoz Aguilera (UCL Eastman Dental Institute) said: “Elevated blood pressure is usually asymptomatic, and many individuals with gum disease may be unaware that they are at increased risk of cardiovascular complications. We aimed to investigate the association between severe periodontitis and high blood pressure in healthy adults without a confirmed diagnosis of hypertension.”
For this case-control study, researchers at UCL Eastman Dental Institute included 250 adults with generalised, severe periodontitis (≥50% of teeth with gum infection) and a control group of 250 adults who did not have severe gum disease, all of whom were otherwise healthy and had no other known chronic health conditions.
All participants underwent comprehensive periodontal examinations, which measured gum disease severity, such as full-mouth dental plaque, bleeding of the gums and the depth of the infected gum pockets. Blood pressure assessments were measured three times for each participant to ensure accuracy. Fasting blood samples were also collected and analysed for high levels of white blood cells and high sensitivity C-reactive protein (hsCRP), as both are markers of increased inflammation in the body. To control for other variables, researchers also assessed information relating to family history of cardiovascular disease, age, body mass index, gender, ethnicity, smoking and physical activity levels.
The researchers found that a diagnosis of gum disease was associated with higher odds of high blood pressure, independent of common cardiovascular risk factors.
Individuals with gum disease were twice as likely to have high systolic blood pressure values ≥140 mm Hg (UK/EU clinical guidelines’ minimum value for hypertension), compared to people with healthy gums (14% and 7%, respectively).
Researchers also found participants with periodontitis exhibited increased glucose, LDL (“bad” cholesterol), hsCRP and white blood cell levels, and lower HDL (“good” cholesterol) levels compared to those in the control group.
Nearly 50% of participants with gum disease and 42% of the control group had blood pressure values for a diagnosis of hypertension, defined as ≥ 130/80 mmHg (US clinical guidelines’ minimum value for hypertension)
Corresponding author, Professor Francesco D’Aiuto, (UCL Eastman Dental Institute), said: “This evidence indicates that periodontal bacteria cause damage to the gums and also trigger inflammatory responses that can impact the development of systemic diseases including hypertension.
“This would mean that the link between gum disease and elevated blood pressure occurs well before a patient develops high blood pressure. Our study also confirms that a worryingly high number of individuals are unaware of a possible diagnosis of hypertension.”
Prevention and treatment of periodontitis is cost effective and can lead to the reduction of systemic markers of inflammation as well as improvement in function of the endothelium (thin membrane lining the inside of the heart and blood vessels).
Professor D’Aiuto added: “If dental professionals were able to screen for hypertension and refer to primary care, and medical professionals were able to screen for periodontal diseases and refer to periodontists, this would improve detection and treatment of both conditions, improving oral health and reducing the burden of hypertension and its complications. Oral health strategies such as brushing teeth twice daily are proven to be very effective in managing and preventing the most common oral conditions, and our study’s results indicate they can also be a powerful and affordable tool to help prevent hypertension.”
Previous studies have found an association between hypertension and periodontitis. However, research confirming the details of this association is scarce.
This study did not account for other factors that may also impact blood pressure, such as abdominal obesity, salt intake, use of anti-inflammatory medications, hormone treatments or stress, or any other oral health conditions
This study received funding from the NIHR Biomedical Research Centre at UCL /University College London Hospitals.
- Research paper published in Hypertension
- Dr Eva Muñoz Aguilera's academic profile
- Professor Francesco D’Aiuto's academic profile
- UCL Eastman Dental Institute
- ‘Female dentist treating her patient’, credit Andrea Piacquadio on Pexels, CC BY 2.0
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