Treating Periodontitis Reduces Inflammatory Markers and Blood Pressure in Hypertensive Patients

Researchers here provide evidence for periodontitis, gum disease, to contribute to hypertension, chronic raised blood pressure, via inflammatory mechanisms. Aggressively treating the periodontitis in hypertensive patients reduces both blood pressure and inflammatory markers. Periodontitis has previously been linked with a modestly increased risk of dementia, as well as increased cardiovascular mortality risk. In both cases, increased inflammation is strongly suspected to be the linking mechanism.

Experimental and observational clinical evidence suggests a prominent role of inflammation in the development of hypertension. In particular, activation of immune cells has been demonstrated in hypertension. Hypertension is more prevalent in patients with immune-mediated disorders, such as psoriasis, rheumatoid arthritis or systemic lupus erythematosus. Thus, chronic inflammatory disorders, could provide a substrate for the pro-hypertensive inflammation.

Periodontitis is one of the most common inflammatory conditions worldwide, representing the sixth most prevalent condition worldwide with prevalence of 20-50%. It is linked to cardiovascular inflammation and endothelial dysfunction. Therefore, if causally associated, periodontitis could significantly contribute to the global hypertensive burden and interventions targeting oral inflammation would have an important role in the prevention of hypertension and its complications. Observational evidence suggests that moderate-severe periodontitis is associated with increased odds for hypertension.

Because of this, it is imperative to establish if periodontitis can cause hypertension. Our group has recently shown that immune activation induced by a keystone periodontal pathogen (Porphyromonas gingivalis) promotes the development of hypertension in mice. Small interventional studies concluded that intensive periodontal therapy may lead to blood pressure reduction, although sufficiently powered evidence in well-defined hypertensive cohorts is lacking. We thus performed a randomized intervention trial on the effects of treatment of periodontitis on blood pressure. One hundred and one hypertensive patients with moderate to severe periodontitis were randomized to intensive periodontal treatment (IPT) or control periodontal treatment (CPT) with systolic blood pressure (SBP) as the primary outcome.

Intensive periodontal treatment improved periodontal status at 2 months, compared to CPT. This was accompanied by a substantial reduction in mean SBP in IPT compared to the CPT (mean difference of -11.1 mmHg). Systolic BP reduction was correlated to periodontal status improvement. Diastolic blood pressure and endothelial function (flow-mediated dilation) were also improved by IPT. These cardiovascular changes were accompanied by reductions in circulating IFN-γ and IL-6 as well as activated and immunosenescent CD8+ T cells, previously implicated in hypertension.

Link: https://doi.org/10.1093/eurheartj/ehz646

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