Physicians' Academy for Cardiovascular Education

Periodontitis negatively affects antihypertensive treatment success at high BP

Poor Oral Health and Blood Pressure Control Among US Hypertensive Adults

Literature - Pietropaoli D, Del Pinto R, Ferri C et al. - Hypertension 2018;72:00-00

Introduction and methods

Periodontitis, a chronic inflammatory disorder of tissues surrounding the teeth [1], is associated with many CV risk factors and related diseases, such as endothelial dysfunction [2-4], hypertension [5,6], atherosclerosis [7,8] and major CV events [5,6,9-12]. Although some studies have shown beneficial effects of periodontal treatment on blood pressure (BP) [13,14], data on the effect of periodontitis on BP control in patients with antihypertensive treatment are lacking. Therefore, this study aimed to examine the relation between periodontitis and uncontrolled hypertension in treated hypertensive patients enrolled in the National Health and Nutrition Examination Survey (NHANES).

This retrospective cross-sectional analysis of the NHANES assessed arterial BP in hypertensive adults with (n=1,834) versus without (n=1,694) periodontitis, aged ≥30 years on prescribed medicine for high BP with at least one natural tooth. Subjects with a history of heart transplant, artificial heart valve, congenital heart disease not including mitral valve prolapse, or bacterial endocarditis were excluded for periodontal examination.

Disease severity was defined as mild, moderate or severe according to the gold standard full-mouth periodontitis surveillance protocol following suggested Centers for Disease Control and Prevention/American Academy of Periodontology case definitions [1]. Arterial BP was measured by trained and calibrated physicians using a mercury sphygmomanometer according to standardized BP measurement protocols [15].

Main results


Hypertensive patients without periodontitis show a better SBP during antihypertensive treatment by about 2.3-3.0 mmHg and lower odds of treatment failure than hypertensives without periodontitis. The data suggest that antihypertensive therapy in the presence of periodontitis may be less effective as compared with good oral health. Dedicated studies may focus on the effect of periodontal therapy on BP in treated hypertensive patients.


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