Active gingival inflammation tied to hypertension

Gingival bleeding appears to influence the association between periodontal diseases and blood pressure (BP), a study has shown. However, the burden represented by periodontitis is still vital. Periodontal assessment may be essential in difficult to control hypertension.

The authors applied survey-based propensity-score matching (PSM) that included major confounders shared between hypertension and periodontal diseases to cross-sectional NHANES III data from 5,396 adults aged ≥30 years who underwent BP measurement and periodontal examination. Two matched groups with and without gingival bleeding were identified.

Generalized additive models incorporating inflammatory markers were fitted to examine the association of bleeding gums with systolic (S)BP and high/uncontrolled BP. Stratification by periodontal status (healthy, gingivitis, stable periodontitis, or unstable periodontitis) was conducted. Machine learning was used to estimate variable importance.

Compared with no bleeding (healthy periodontium, stable periodontitis), gingival bleeding (gingivitis, unstable periodontitis) independently correlated with 2.6-mm Hg higher SBP (p<0.001) and with an increased risk of high/uncontrolled BP (odds ratio [OR], 1.42, 95 percent confidence interval [CI], 1.19–1.68; p<0.001). SBP was also higher among participants with unstable periodontitis than those with stable periodontitis (2.1 mm Hg; p<0.001) or gingivitis (5.3 mm Hg; p<0.001).

Moreover, unstable periodontitis (OR, 1.65, 95 percent CI, 2.14–1.82) and gingivitis (OR, 1.49, 95 percent CI, 1.22–1.82) showed a consistent relationship with an increased risk of high/uncontrolled BP. Notably, inflammatory markers conferred a maximum of 12-percent gain in the predictive power of the model.

“Cardiovascular diseases, including hypertension, are characterized by underlying systemic inflammation,” the authors said. “Periodontitis, which can impact the systemic inflammatory burden, has recently been linked to high BP.”