Study finds hy­per­ten­sion worse with pe­ri­odon­ti­tis

Daily Press - - Front Page - By Melissa Healy Los An­ge­les Times

That’s right, the two could ac­tu­ally be linked. Re­search sug­gests blood pressure and as­so­ci­ated ills go higher as teeth and gums de­cline.

Strug­gling to bring your high blood pressure un­der con­trol, even with the help of med­i­ca­tions?

Open your mouth and say “aha!” if you see tooth de­cay or gums that are sore, bleed­ing or re­ced­ing. You may have found the cul­prit.

Re­searchers re­cently re­ported that in adults whose hy­per­ten­sion was be­ing treated with med­i­ca­tions, sys­tolic blood pressure — which mea­sures pressure in the ves­sels when the heart beats — got higher as the health of their teeth and gums de­clined.

Com­pared with hy­per­ten­sive pa­tients who had no signs of pe­ri­odon­tal dis­ease, those with in­flamed gums were 20 per­cent less likely to have got­ten their blood pressure within healthy lim­its. In ad­di­tion, pa­tients whose den­tal health was poor had sys­tolic blood pressure read­ings that were 3 mm HG higher, on aver­age, than sim­i­lar pa­tients with healthy gums.

The find­ings were pub­lished in the jour­nal Hy­per­ten­sion.

An es­ti­mated one-inthree U.S. adults are thought to have high blood pressure, putting them at greater risk of heart at­tacks and strokes. Hy­per­ten­sion is a pri­mary or con­tribut­ing cause of more than 1,000 deaths a day in the U.S. Yet only 54 per­cent of those with the con­di­tion have brought their blood pressure read­ings un­der con­trol with some com­bi­na­tion of med­i­ca­tion, diet and ex­er­cise.

The new study is in line with a moun­tain of re­search link­ing gum dis­ease with higher rates of heart, blood ves­sel and kid­ney dis­ease — all or­gans that are af­fected by high blood pressure. And it breaks new ground by de­tail­ing how poor den­tal health up­ends ef­forts to bring hy­per­ten­sion un­der con­trol.

In­deed, the study found that peo­ple with un­treated hy­per­ten­sion and healthy gums had blood pressure read­ings roughly equal to those of peo­ple who took med­i­ca­tion for their hy­per­ten­sion but also suf­fered from gum dis­ease.

In other words, poor den­tal health largely negated the ef­fects of taking blood pressure med­i­ca­tion.

The new re­search doesn’t es­tab­lish that gum dis­ease causes hy­per­ten­sion and its neg­a­tive health ef­fects. Many re­searchers sus­pect that, like stiff blood ves­sels, sore and bleed­ing gums are just one more man­i­fes­ta­tion of in­flam­ma­tion through­out the body.

Nor does the study show that treat­ing pe­ri­odon­ti­tis will re­duce high blood pressure. But it does sug­gest that, when den­tal health is poor, the chal­lenge of bring­ing blood pressure un­der con­trol will be more ex­pen­sive and is more likely to fail.

Re­searchers from Italy scoured the records of

11,753 Amer­i­cans who par­tic­i­pated in the Na­tional Health and Nu­tri­tion Ex­am­i­na­tion Sur­vey be­tween 2009 and 2014, and were screened for pe­ri­odon­tal dis­ease.

Some 4,095 of the par­tic­i­pants had been di­ag­nosed with hy­per­ten­sion, of whom 88.5 per­cent were taking med­i­ca­tion for the con­di­tion and 11.5 per­cent were not.

Rates of mod­er­ate and se­vere pe­ri­odon­tal dis­ease tended to be higher among study par­tic­i­pants who were men, older, Latino, smok­ers, and those with less in­come and ed­u­ca­tion. Par­tic­i­pants who were 65 or older and had ev­i­dence of long-stand­ing pe­ri­odon­tal dis­ease were much more likely than those with less se­vere and long-stand­ing gum dis­ease to have unchecked high blood pressure — a trend that was par­tic­u­larly ev­i­dent among Lati­nos.

Both hy­per­ten­sion and pe­ri­odon­ti­tis are more com­mon among AfricanAmer­i­cans and Lati­nos in the U.S. Those pa­tient pop­u­la­tions also have strik­ingly higher rates of the diseases linked to both, in­clud­ing heart dis­ease, kid­ney fail­ure and cere­brovas­cu­lar diseases such as stroke and cer­tain forms of de­men­tia.

There’s lit­tle doubt that ac­cess to health care dif­fers by race and eth­nic­ity, and that im­ped­i­ments to good med­i­cal and den­tal care play a key role in racial and eth­nic health dis­par­i­ties. Den­tal care, es­pe­cially, is ex­pen­sive and far less likely than med­i­cal care to be fully cov­ered by in­sur­ance. As a re­sult, eco­nomic fac­tors likely play a pow­er­ful role in in­flu­enc­ing the health of a pa­tient’s gums.

More­over, many pri­mary care physi­cians and car­di­ol­o­gists fail to ask their pa­tients about their den­tal health, or to re­fer them to den­tists un­less they are un­der­go­ing car­diac pro­ce­dures and have clear signs of tooth de­cay. And den­tists don’t nec­es­sar­ily check their pa­tients’ blood pressure.

The study au­thors wrote that pa­tients with high blood pressure should have their gum health taken into ac­count when they con­sider their treat­ment op­tions.

“Our data sug­gest that all racial/eth­nic sub­groups, es­pe­cially His­pan­ics, might ben­e­fit of such ap­proach,” they wrote. “Con­versely, ig­nor­ing the ad­di­tional bur­den of poor pe­ri­odon­tal sta­tus on blood pressure might trans­late into a higher car­dio­vas­cu­lar risk in the long term.”

At a time when fed­eral health in­sur­ance for the poor and dis­abled is be­ing scaled back and the re­quire­ments of the Af­ford­able Care Act are be­ing whit­tled away, it’s un­likely that pa­tients with gum dis­ease will get bet­ter ac­cess to den­tal care any time soon.

But if they did, it might help, said Dr. Gregg Fonarow, a car­di­ol­o­gist at UCLA.

“It’s sug­gested by this data but would need to be proven,” Fonarow said.

In the mean­time, he said, the ex­is­tence of a link is clear: Pa­tients with hy­per­ten­sion should make every ef­fort to im­prove their oral health, and those with poor gum health should be vig­i­lant for hy­per­ten­sion.


An­other rea­son to take care of your teeth: Pe­ri­odon­tal dis­ease may in­ter­fere with blood pressure con­trol in peo­ple who have been di­ag­nosed with hy­per­ten­sion, a new study says.

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