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Association between periodontitis and arterial hypertension: A systematic review and meta-analysis
Abstract
Background Several studies have shown that periodontal diseases are associated with hypertension (HT). However, heterogeneity among populations, diagnosis criteria, and shared risk factors represent some difficulties in terms of interpretation. Therefore, the aim of this study was to determine the magnitude of the association between periodontal diseases and HT.Methods and results A systematic review and meta-analysis, including studies published up to June 2016, have been performed. Sixteen studies assessing the association between periodontal diseases and HT have been included. The meta-analysis considering all included studies (moderate to severe periodontitis) showed that the presence of HT was associated with the presence of periodontal diseases (OR, 1.50; 95% CI, 1.27-1.78). To reduce potential bias, a stratified analysis has been performed illustrating the impact of inclusion criteria and adjustments on the magnitude of the association. Interestingly, when only studies with secure diagnosis of severe periodontitis and HT were considered, an OR=1.64 (95% CI, 1.23-2.19) has been measured.Conclusions Periodontal diseases are associated with a higher risk of HT especially for severe periodontitis. However, no conclusions could be made regarding the causative involvement of periodontal diseases mainly due to the reduced number of available prospective studies and remaining questions regarding underlying biological mechanisms.
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“The magnitude of association between periodontitis and hypertension reported in this review (OR 1.22-1.53) is in agreement with that recently reported.27”
From Periodontitis is associated with hypertension: a systematic review and meta-analysis (2020) · cites this paper as [27]
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“Diagnostic criteria of PD include at least two sites on different teeth with clinical attachment level (CAL) > 6 mm with probing pocket depth (PPD) >6 mm, at least five sites with CAL > 6 mm, PPD > 6 mm, or CAL > 5 mm.[15]”
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“Thus, many cardiovascular risk factors and interrelated diseases, as well as HTN [33, 34] and atherosclerosis [35, 36], have been correlated with periodontitis.”
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“Recommendations for evaluation and treatment of periodontitis with systemic diseases including diabetes mellitus and hypertension is generally accepted,([9,10]) and the general recommendation for individuals without systemic diseases is not well”
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“These diseases are also reported to be related to periodontitis, which may affect the relationship between periodontitis and stroke.(25,26) To avoid this, we adjusted for both diabetes and hypertension in logistic regression analysis.”
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Szczepaniak, P., Mikolajczyk, T. P., Cześnikiewicz‐Guzik, M., & Guzik, T. J. (2021) · Kardiologia Polska · doi:10.33963/kp.a2021.0161 · Cited by 17
Furuta, M., Fukai, K., Aida, J., Shimazaki, Y., Ando, Y., Miyazaki, H., Kambara, M., & Yamashita, Y. (2019) · Journal of Oral Science · doi:10.2334/josnusd.18-0128 · Cited by 15
The link between periodontitis and erectile dysfunction: a review
Bizzarro, S., & Loos, B. G. (2019) · BDJ · doi:10.1038/s41415-019-0724-6 · Cited by 14
Morales-Ruiz, P., Moreno-Barrera, A., Perez, D. R., Menacho, D. R., Fraile, J. F., Gómez-Salgado, J. C., & Castaño-Seiquer, A. L. (2023) · Medicine · doi:10.1097/md.0000000000035748 · Cited by 13
“…periodontitis, although, to date, there is no definitive evidence to indicate that periodontal disease is a risk for increased blood pressure, although it is a risk for other pathologies such as DM. [45,46] We have also obtained a curious association between the CPI value and digestive pathology.”
BackgroundKurushima, Y., Bowyer, R. C. E., Ide, M., Hughes, F. J., & Steves, C. J. (2018) · Journal Of Clinical Periodontology · doi:10.1111/jcpe.13045 · Cited by 13
Li, J., Yao, Y., Yin, W., Feng, S., Yan, P., Wang, L., Xiao, Z., Zhang, K., Tian, J., Wang, Z., et al. (2024) · BMC Oral Health · doi:10.1186/s12903-024-04708-6 · Cited by 12
“The relationship between periodontitis and hypertension remains filled with many uncertainties [27].”
BackgroundLee, J., & Jeong, S. (2020) · Medicina · doi:10.3390/medicina56110575 · Cited by 12
Abe, T., Tominaga, K., Ando, Y., Hamano, T., Yano, S., Isomura, M., & Nabika, T. (2022) · Hypertension Research · doi:10.1038/s41440-022-00976-3 · Cited by 11
Expression of neprilysin in periodontitis-affected gingival tissues
Nezu, A., Kubota, T., Maruyama, S., Nagata, M., Nohno, K., Morozumi, T., & Yoshie, H. (2017) · Archives of Oral Biology · doi:10.1016/j.archoralbio.2017.03.003 · Cited by 12
MicroRNAs: The Missing Link between Hypertension and Periodontitis?
Rodriguez, N. M., Loren, P., Páez, I., Martínez, C., Chaparro, A. P., & Salazar, L. A. (2024) · International Journal of Molecular Sciences · doi:10.3390/ijms25041992 · Cited by 10
“This association can be described by common risk factors or by the diffusion of infectious and inflammatory components of periodontal lesions through the bloodstream, immune response, or glucose and lipid metabolism [70].”
Could the periodontal therapy improve the cardiologic patient health? A narrative review
Bertoldi, C., Salvatori, R., Pinti, M., & Mattioli, A. V. (2024) · Current Problems in Cardiology · doi:10.1016/j.cpcardiol.2024.102699 · Cited by 14
Does Periodontal Treatment Help in Arterial Hypertension Control? A Systematic Review of Literature
Lanau, N., Mareque-Bueno, J., & Zabalza, M. (2020) · European Journal of Dentistry · doi:10.1055/s-0040-1718244 · Cited by 9
Associations between Pharmacotherapy for Cardiovascular Diseases and Periodontitis
Pająk-Łysek, E., Polak, M., Kopeć, G., Podolec, M., Desvarieux, M., Pająk, A., & Zarzecka, J. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18020770 · Cited by 10
“Several studies have shown a consistent increase in the prevalence of periodontitis in patients with hypertension or metabolic syndrome [39,40], patients treated for CVD [41], and patients using antipsychotic medications, which is related to slow salivary rate [42].”
BackgroundOh, E., Jun, J. H., Choi, J. Y., & Yoo, T. K. (2025) · The EPMA Journal · doi:10.1007/s13167-025-00415-6 · Cited by 9
“Furthermore, the relationship between periodontitis and ocular disease is likely mediated and amplified by systemic metabolic comorbidities such as diabetes mellitus, hypertension, and dyslipidemia, which frequently coexist with both periodontal and ocular conditions [43, 44].”
Yildirim, B., Aksit, C., Mutlu, M., Ainola, M., Eklund, K. K., Leskelä, J., Pussinen, P. J., & Beklen, A. (2022) · BMC Oral Health · doi:10.1186/s12903-022-02637-w · Cited by 12
“Despite contradictory results and explanations, most studies have revealed a significant association between periodontal diseases and hypertension [5, 6].”
BackgroundResultAssociations Among Tooth Loss, Periodontitis, and Carotid Intima-Media Thickness: the Nagahama Study
Fukuhara, S., Watanabe, T., Yamazaki, T., Yamanaka, S., Nakao, K., Asai, K., Kashiwagi, M., Yamazaki, A., Umebachi, C., Setoh, K., et al. (2023) · Journal of Atherosclerosis and Thrombosis · doi:10.5551/jat.63801 · Cited by 9
Focusing Heart Failure Research on Myocardial Fibrosis to Prioritize Translation
Lindsey, M. L., DeLeon‐Pennell, K. Y., Bradshaw, A. D., LaRue, R. A. C., Anderson, D. R., Thiele, G. M., Baicu, C. F., Jones, J. A., Menick, D. R., Zile, M. R., et al. (2020) · Journal of Cardiac Failure · doi:10.1016/j.cardfail.2020.05.009 · Cited by 9
“[51, 52] Likewise, periodontal disease is associated with a higher risk of hypertension.[53] Therefore, understanding how underlying inflammation exacerbates HF will provide insight into progression mechanisms.”
BackgroundHayashi, F., Shirai, Y., Ohira, T., Shirai, K., Kondo, N., & Kondo, K. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20095713 · Cited by 9
Association between life’s essential 8 and periodontitis: a study based on NHANES 2009–2014
Hou, K., Zhang, H., Song, W., Li, S., Liu, J., & Ma, Z. (2024) · Frontiers in Medicine · doi:10.3389/fmed.2024.1342792 · Cited by 8
“In addition, associations between obesity, hypertension, and dyslipidemia have also been reported with periodontal diseases (31, 41–44).”
BackgroundPinto, R. D., Landi, L., Grassi, G. M., Sforza, N. M., Cairo, F., Citterio, F., Paolantoni, G., D’Aiuto, F., Ferri, C., Monaco, A., et al. (2021) · Oral Diseases · doi:10.1111/odi.14009 · Cited by 10
Oral Health and Risk of Retinal Vascular Occlusions: A Nationwide Cohort Study
Chang, Y., Kim, S.-H., Jeon, J., Song, T., & Kim, J. (2023) · Journal of Personalized Medicine · doi:10.3390/jpm13010121 · Cited by 8
“Increasing evidence showed that periodontitis is associated with hypertension, diabetes mellitus, cerebrovascular disease, and myocardial infarction [13,21,22].”
BackgroundMetabolic Syndrome and Periodontal Disease
Velioğlu, E. M., AYDINDOĞAN, S., & Hakki, S. S. (2023) · Current Oral Health Reports · doi:10.1007/s40496-023-00334-3 · Cited by 8
Periodontal Disease and Cardiovascular Disease
Zeng, X., Li, N., Zhang, L., Rong, R., & Liu, M. (2017) · Heart and Mind · doi:10.4103/hm.hm_19_17 · Cited by 8
“[30] The results of a meta-analysis also confirmed PD, especially severe PD was associated with a higher risk of hypertension.[31]”
ResultDoble, A., Bescós, R., Witton, R., Shivji, S., Ayres, R., & Brookes, Z. L. S. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20064959 · Cited by 7
Dain, C. P., Ganapathi, S., Ranjithkumar, A., Geevar, Z., Harikrishnan, S., & Ammu, J. V. (2023) · Journal of International Society of Preventive and Community Dentistry · doi:10.4103/jispcd.jispcd_77_23 · Cited by 8
Metadata
- Authors
- Martin-Cabezas, R., Seelam, N., Petit, C., Agossa, K., Gaertner, S., Tenenbaum, H., Davideau, J.-L., & Huck, O.
- Affiliations
- Université de Strasbourg (FR)
- Université de Lille (FR)
- Hôpitaux Universitaires de Strasbourg (FR)
- Inserm (FR)
- Corresponding author
- Huck, Olivier
- Venue
- American Heart Journal
- Publisher
- Elsevier BV
- Published
- 2016-10
- Volume
- 180
- Pages
- 98-112
- ISSN
- 0002-8703 (ISSN-L)
- OpenAlex
- W2487600428
- Cited by
- 183
- References
- 58
- Citations by year
- 2026: 7 · 2025: 6 · 2024: 16 · 2023: 27 · 2022: 25 · 2021: 27 · 2020: 30 · 2019: 18 · 2018: 13 · 2017: 14
- FWCI
- 2.59
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Heart Journal (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion)
- Topics
- Health Sciences › Dentistry › Periodontics › Oral microbiology and periodontitis research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Dentistry › Periodontics › Periodontal Regeneration and Treatments
- Keywords
- periodontitis, hypertension, periodontal disease, severe periodontitis, cardiovascular risk factors, shared risk factors, associative strength
- MeSH terms
- Humans, Hypertension, Periodontitis, Risk Factors
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