Patients with the gum disease periodontitis have a greater likelihood of hypertension and should be informed of their risk and given advice on lifestyle changes to prevent high blood pressure such as exercise and a healthy diet.

The study published in Cardiovascular Research, a journal of the European Society of Cardiology (ESC), found a linear association between the severity of periodontitis and the probability of hypertension. 

High blood pressure affects 30–45% of adults and is the leading global cause of premature death, while periodontitis affects more than 50% of the world’s population. Hypertension is the main preventable cause of cardiovascular disease, and periodontitis has been linked with increased risk of heart attack and stroke.

“Hypertension could be the driver of heart attack and stroke in patients with periodontitis,” said Senior author Professor Francesco D'Aiuto of UCL Eastman Dental Institute. “Previous research suggests a connection between periodontitis and hypertension and that dental treatment might improve blood pressure, but to date the findings are inconclusive.”

In many countries oral health is not checked regularly

This study compiled the best available evidence to examine the odds of high blood pressure in patients with moderate and severe gum disease. A total of 81 studies from 26 countries were included in the meta-analysis.

Moderate-to-severe periodontitis was associated with a 22% raised risk for hypertension, while severe periodontitis was linked with 49% higher odds of hypertension. 

Average arterial blood pressure was higher in patients with periodontitis compared to those without. This amounted to 4.5mmHg higher systolic and 2mmHg higher diastolic blood pressures. 

Just five out of 12 interventional studies included in the review showed a reduction in blood pressure following gum treatment. The changes occurred even in people with healthy blood pressure levels.

Professor D’Aiuto added: “There seems to be a continuum between oral health and blood pressure which exists in healthy and diseased states. The evidence suggesting periodontal therapy could reduce blood pressure remains inconclusive. In nearly all intervention studies, blood pressure was not the primary outcome. Randomised trials are needed to determine the impact of periodontal therapy on blood pressure.

“In many countries throughout the world, oral health is not checked regularly, and gum disease remains untreated for many years. The hypothesis is that this situation of oral and systemic inflammation and response to bacteria accumulates on top of existing risk factors.”