Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, New York, USA.
Medical Scientist Training Program, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA.
Am J Hypertens. 2019 Jan 15;32(2):193-201. doi: 10.1093/ajh/hpy164.
Multiple cross-sectional epidemiologic studies have suggested an association between periodontal disease and tooth loss and hypertension, but the temporality of these associations remains unclear. The objective of our study was to evaluate the association of baseline self-reported periodontal disease and edentulism with incident hypertension.
Study participants were 36,692 postmenopausal women in the Women's Health Initiative-Observational Study who were followed annually from initial periodontal assessment (1998-2003) through 2015 (mean follow-up 8.3 years) for newly diagnosed treated hypertension. Cox proportional hazards regression with adjustment for potential confounders was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs).
Edentulism was significantly associated with incident hypertension in crude (HR (95% CI) = 1.38 (1.28-1.49)) and adjusted (HR (95% CI) = 1.21 (1.11-1.30)) models. This association was stronger among those <60 years compared to ≥60 years (P interaction 0.04) and among those with <120 mm Hg systolic blood pressure, compared to those with ≥120 mm Hg (P interaction 0.004). No association was found between periodontal disease and hypertension.
These findings suggest that edentulous postmenopausal women may represent a group with higher risk of developing future hypertension. As such improved dental hygiene among those at risk for tooth loss as well as preventive measures among the edentulous such as closer blood pressure monitoring, dietary modification, physical activity, and weight loss may be warranted to reduce disease burden of hypertension. Further studies are needed to clarify these results and further elucidate a potential role of periodontal conditions on hypertension risk.
多项横断面流行病学研究表明，牙周病和牙齿缺失与高血压之间存在关联，但这些关联的时间顺序尚不清楚。我们的研究目的是评估基线自我报告的牙周病和无牙症与新发高血压的相关性。
研究参与者是参加妇女健康倡议观察研究的 36692 名绝经后妇女，从初始牙周评估（1998-2003 年）开始，通过 2015 年（平均随访 8.3 年），对新诊断的高血压进行了随访。使用调整潜在混杂因素的 Cox 比例风险回归来计算风险比（HR）和 95%置信区间（CI）。
在未调整（HR（95%CI）=1.38（1.28-1.49））和调整（HR（95%CI）=1.21（1.11-1.30））模型中，无牙症与新发高血压显著相关。与≥60 岁相比，年龄<60 岁的患者相关性更强（P 交互作用 0.04），与收缩压<120mmHg 的患者相比，收缩压≥120mmHg 的患者相关性更强（P 交互作用 0.004）。牙周病与高血压之间无关联。
这些发现表明，无牙的绝经后妇女可能代表了一个未来发生高血压风险更高的群体。因此，对于有牙齿脱落风险的人群，应加强口腔卫生，对于无牙的人群，如更密切的血压监测、饮食调整、体育锻炼和减肥等预防措施，可能有助于降低高血压的疾病负担。需要进一步的研究来阐明这些结果，并进一步阐明牙周状况对高血压风险的潜在作用。
