GINGIVAL BLEEDING: A POSSIBLE INDICATOR OF HIGH BLOOD PRESSURE?

Abstract

Objective: Cardiovascular disease (CVD) and related risk factors, including hypertension, are characterized by systemic inflammation. Periodontitis, a chronic inflammatory disease of the supporting tissues of the tooth, has recently been associated with hypertension. However, it is not clear whether the risk of hypertension can vary throughout the natural history of periodontal diseases, that is, if it is modified by gingival bleeding, an easily investigable indicator of local pathology. Design and method: Survey-based propensity score matching (PSM) incorporating major confounders shared between hypertension and periodontal diseases (age, gender, ethnicity, poverty, BMI, hypertension diagnosis and treatment, smoking habit, diabetic status, aspirin use) was applied to cross-sectional NHANES III data from adults > = 30 years who underwent BP measurement and periodontal examination, identifying two matched groups with/without gingival bleeding. The association of bleeding gums with systolic blood pressure (BP, mmHg) and high/uncontrolled BP according to the European Society of Hypertension (ESH) was then assessed with generalized additive models incorporating inflammatory markers (CRP, white blood cells, ferritin). Stratification by periodontal health status (healthy; gingivitis; stable/unstable periodontitis) was performed. Results: Gingival bleeding (gingivitis; unstable periodontitis) was independently associated with +2.6 mmHg (p < 0.001) systolic BP compared with no bleeding (healthy periodontium; stable periodontitis), and with greater odds (OR 1.42, p < 0.001) of high/uncontrolled BP. Participants with unstable periodontitis had higher systolic BP than those with stable periodontitis (+2.1 mmHg; p < 0.001) or gingivitis (+5.3 mmHg; p < 0.001). Unstable periodontitis and gingivitis, but not stable periodontitis, were associated with increased risk of high/uncontrolled BP (OR 1.29, p = 0.046; OR 1.98, p < 0.001 respectively). Conclusions: Gingival bleeding contributes to shaping the relationship between periodontal diseases and hypertension. Inflammatory pathways specific for acute and chronic settings and the immunological/metabolic effects of microflora fluctuations might explain differences among disease strata in the association. Guidelines now recommend oral and periodontal examination in patients with CVD, and warn of the increased cardiovascular risk in the presence of periodontitis. Whether periodontal treatment in hypertension is a cost-effective measure for CV prevention is still undetermined; our results add to the existing observational evidence in support of this possibility.