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Poor oral health linked to worse blood pressure control

Patients are more likely to benefit from antihypertensive therapy if they have good oral health

Ingrid Torjesen

Tuesday, 23 October 2018

People with high blood pressure are more likely to benefit from antihypertensives if they have good oral health, according to research* published in the American Heart Association's journal Hypertension.

The study included 11,753 patients who underwent dental examination, of which 3,626 people were being treated for high blood pressure.

The researchers found that patients with healthier gums had lower blood pressure and responded better to blood pressure-lowering medications, compared with individuals who have gum disease (periodontitis). People with periodontal disease were 20% less likely to reach healthy blood pressure ranges, compared with patients in good oral health.

Patients with severe periodontitis had systolic pressure that was, on average, 3 mmHg higher than those with good oral health. While seemingly small, the 3 mmHg difference is similar to the reduction in blood pressure that can be achieved by reducing salt intake by 6 grams per day (equal to a teaspoon of salt, or 2.4 grams of sodium), the researchers said.

The presence of periodontal disease widened the gap even farther, up to 7 mmHg, among people with untreated hypertension, the study found. Blood-pressure medication narrowed the gap, down to 3 mmHg, but did not completely eliminate it, suggesting that periodontal disease may interfere with the effectiveness of blood pressure therapy.

"Physicians should pay close attention to patients' oral health, particularly those receiving treatment for hypertension, and urge those with signs of periodontal disease to seek dental care," said study lead investigator Davide Pietropaoli, of the University of L'Aquila in Italy.

"Likewise, dental health professionals should be aware that oral health is indispensable to overall physiological health, including cardiovascular status," he said

While the study was not designed to clarify exactly how periodontal disease interferes with blood pressure treatment, the researchers say their results are consistent with previous research that links low-grade oral inflammation with blood vessel damage and cardiovascular risk.

*Pietropaoli D, Pinto RD, FerriPoor C, et al. Oral Health and Blood Pressure Control Among US Hypertensive Adults. Results From the National Health and Nutrition Examination Survey 2009 to 2014. Originally published 22 Oct 2018, Hypertension. 2018;0:HYPERTENSIONAHA.118.11528

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