Is systemic inflammation a missing link between periodontitis and hypertension? Results from two large population‐based surveys
Objective The primary objective was to investigate the relationship between periodontitis and hypertension in two independent large surveys. The secondary objective was to ascertain whether systemic inflammation had a mediation effect in the association. Methods This cross‐sectional study analysed r...
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| Veröffentlicht in: | Journal of internal medicine 2021-04, Vol.289 (4), p.532-546 |
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| creator | Muñoz Aguilera, E. Leira, Y. Miró Catalina, Q. Orlandi, M. Czesnikiewicz‐Guzik, M. Guzik, T. J. Hingorani, A. D. Nart, J. D’Aiuto, F. |
| description | Objective
The primary objective was to investigate the relationship between periodontitis and hypertension in two independent large surveys. The secondary objective was to ascertain whether systemic inflammation had a mediation effect in the association.
Methods
This cross‐sectional study analysed representative samples of the US (n = 3460; NHANES 2009/10) and Korean (n = 4539; 2015 KNHANES VI‐3) populations. The association between periodontitis (exposure), hypertension (outcome) and inflammatory markers [C‐reactive protein (CRP) and white blood cell counts (WBC)] (mediators) was assessed using multivariate linear and logistic regression models and mediation analysis.
Results
Participants with periodontitis were more likely to have hypertension (NHANES: OR = 1.3, 95% CI: 1.0–1.6, P = 0.025; KNHANES: OR = 1.2, 95% CI: 1.0–1.4, P = 0.041) and actual systolic blood pressure ≥ 140 mmHg (NHANES: OR = 1.6, 95% CI: 1.1–2.3, P |
| doi_str_mv | 10.1111/joim.13180 |
| format | Article |
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The primary objective was to investigate the relationship between periodontitis and hypertension in two independent large surveys. The secondary objective was to ascertain whether systemic inflammation had a mediation effect in the association.
Methods
This cross‐sectional study analysed representative samples of the US (n = 3460; NHANES 2009/10) and Korean (n = 4539; 2015 KNHANES VI‐3) populations. The association between periodontitis (exposure), hypertension (outcome) and inflammatory markers [C‐reactive protein (CRP) and white blood cell counts (WBC)] (mediators) was assessed using multivariate linear and logistic regression models and mediation analysis.
Results
Participants with periodontitis were more likely to have hypertension (NHANES: OR = 1.3, 95% CI: 1.0–1.6, P = 0.025; KNHANES: OR = 1.2, 95% CI: 1.0–1.4, P = 0.041) and actual systolic blood pressure ≥ 140 mmHg (NHANES: OR = 1.6, 95% CI: 1.1–2.3, P < 0.001; KNHANES: OR = 1.3, 95% CI :1.0–1.6, P < 0.031) than those without the disease. These associations were independent of age, gender, BMI, education level, smoking, alcohol consumption, creatinine, physical activity, presence of other comorbidities and confirmed in participants not taking antihypertensive medications. Diagnosis of periodontitis was directly associated with WBC (in both surveys: NHANES: β ± SE = 0.3 ± 0.1, P < 0.004; KNHANES: β ± SE = 0.3 ± 0.1, P < 0.001) and with CRP levels (in one survey: NHANES: β ± SE = 0.1 ± 0.03, P < 0.007; KNHANES: β ± SE = 0.1 ± 0.04, P > 0.213). Mediation analyses confirmed that CRP acted as a mediator in the association between periodontitis and hypertension in both populations (mediated effect: NHANES: β ± SE = 0.010 ± 0.003, P < 0.001; KNHANES: β ± SE = 0.003 ± 0.001, P = 0.015). WBC acted as a mediator in the KNHANES (mediated effect: β ± SE = 0.004 ± 0.001, P = 0.004) whilst in the NHANES, its effect was dependent of CRP inclusion in the model (mediated effect WBC + CRP: β ± SE = 0.002 ± 0.001, P = 0.001).
Conclusions
These findings suggest that periodontitis is closely linked to hypertension and systemic inflammation is, in part, a mediator of this association.]]></description><identifier>ISSN: 0954-6820</identifier><identifier>EISSN: 1365-2796</identifier><identifier>DOI: 10.1111/joim.13180</identifier><identifier>PMID: 32969093</identifier><language>eng</language><publisher>England: Blackwell Publishing Ltd</publisher><subject>Antihypertensives ; Blood pressure ; C-Reactive Protein - analysis ; Creatinine ; Cross-Sectional Studies ; CRP ; Gum disease ; high blood pressure ; Humans ; Hypertension ; Hypertension - epidemiology ; Inflammation ; Inflammation - epidemiology ; leucocytes ; Leukocytes ; Nutrition Surveys ; Periodontitis ; Periodontitis - epidemiology ; Physical activity ; Polls & surveys ; Populations ; Regression analysis ; Regression models ; Republic of Korea - epidemiology ; systemic inflammation ; United States - epidemiology</subject><ispartof>Journal of internal medicine, 2021-04, Vol.289 (4), p.532-546</ispartof><rights>2020 The Authors. published by John Wiley & Sons Ltd on behalf of Association for Publication of The Journal of Internal Medicine.</rights><rights>2020 The Authors. Journal of Internal Medicine published by John Wiley & Sons Ltd on behalf of Association for Publication of The Journal of Internal Medicine.</rights><rights>2020. This article is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4590-848d32ae4763b50c2312b84b544968803a1db1fe4971e1a1df23eee5d0a3924a3</citedby><cites>FETCH-LOGICAL-c4590-848d32ae4763b50c2312b84b544968803a1db1fe4971e1a1df23eee5d0a3924a3</cites><orcidid>0000-0002-7444-1373 ; 0000-0001-8365-0081 ; 0000-0002-2363-4992 ; 0000-0002-1173-3029 ; 0000-0001-7379-4671 ; 0000-0001-8654-935X ; 0000-0001-5027-7276 ; 0000-0002-5039-7849 ; 0000-0002-2225-5624</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fjoim.13180$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fjoim.13180$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,1417,1433,27924,27925,45574,45575,46409,46833</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32969093$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Muñoz Aguilera, E.</creatorcontrib><creatorcontrib>Leira, Y.</creatorcontrib><creatorcontrib>Miró Catalina, Q.</creatorcontrib><creatorcontrib>Orlandi, M.</creatorcontrib><creatorcontrib>Czesnikiewicz‐Guzik, M.</creatorcontrib><creatorcontrib>Guzik, T. J.</creatorcontrib><creatorcontrib>Hingorani, A. D.</creatorcontrib><creatorcontrib>Nart, J.</creatorcontrib><creatorcontrib>D’Aiuto, F.</creatorcontrib><title>Is systemic inflammation a missing link between periodontitis and hypertension? Results from two large population‐based surveys</title><title>Journal of internal medicine</title><addtitle>J Intern Med</addtitle><description><![CDATA[Objective
The primary objective was to investigate the relationship between periodontitis and hypertension in two independent large surveys. The secondary objective was to ascertain whether systemic inflammation had a mediation effect in the association.
Methods
This cross‐sectional study analysed representative samples of the US (n = 3460; NHANES 2009/10) and Korean (n = 4539; 2015 KNHANES VI‐3) populations. The association between periodontitis (exposure), hypertension (outcome) and inflammatory markers [C‐reactive protein (CRP) and white blood cell counts (WBC)] (mediators) was assessed using multivariate linear and logistic regression models and mediation analysis.
Results
Participants with periodontitis were more likely to have hypertension (NHANES: OR = 1.3, 95% CI: 1.0–1.6, P = 0.025; KNHANES: OR = 1.2, 95% CI: 1.0–1.4, P = 0.041) and actual systolic blood pressure ≥ 140 mmHg (NHANES: OR = 1.6, 95% CI: 1.1–2.3, P < 0.001; KNHANES: OR = 1.3, 95% CI :1.0–1.6, P < 0.031) than those without the disease. These associations were independent of age, gender, BMI, education level, smoking, alcohol consumption, creatinine, physical activity, presence of other comorbidities and confirmed in participants not taking antihypertensive medications. Diagnosis of periodontitis was directly associated with WBC (in both surveys: NHANES: β ± SE = 0.3 ± 0.1, P < 0.004; KNHANES: β ± SE = 0.3 ± 0.1, P < 0.001) and with CRP levels (in one survey: NHANES: β ± SE = 0.1 ± 0.03, P < 0.007; KNHANES: β ± SE = 0.1 ± 0.04, P > 0.213). Mediation analyses confirmed that CRP acted as a mediator in the association between periodontitis and hypertension in both populations (mediated effect: NHANES: β ± SE = 0.010 ± 0.003, P < 0.001; KNHANES: β ± SE = 0.003 ± 0.001, P = 0.015). WBC acted as a mediator in the KNHANES (mediated effect: β ± SE = 0.004 ± 0.001, P = 0.004) whilst in the NHANES, its effect was dependent of CRP inclusion in the model (mediated effect WBC + CRP: β ± SE = 0.002 ± 0.001, P = 0.001).
Conclusions
These findings suggest that periodontitis is closely linked to hypertension and systemic inflammation is, in part, a mediator of this association.]]></description><subject>Antihypertensives</subject><subject>Blood pressure</subject><subject>C-Reactive Protein - analysis</subject><subject>Creatinine</subject><subject>Cross-Sectional Studies</subject><subject>CRP</subject><subject>Gum disease</subject><subject>high blood pressure</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Hypertension - epidemiology</subject><subject>Inflammation</subject><subject>Inflammation - epidemiology</subject><subject>leucocytes</subject><subject>Leukocytes</subject><subject>Nutrition Surveys</subject><subject>Periodontitis</subject><subject>Periodontitis - epidemiology</subject><subject>Physical activity</subject><subject>Polls & surveys</subject><subject>Populations</subject><subject>Regression analysis</subject><subject>Regression models</subject><subject>Republic of Korea - epidemiology</subject><subject>systemic inflammation</subject><subject>United States - epidemiology</subject><issn>0954-6820</issn><issn>1365-2796</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>WIN</sourceid><sourceid>EIF</sourceid><recordid>eNp9kctu1TAQhi0EoqeFDQ-ALLFBlVJ8y8UrVFVcDiqqhGBtOcmk-ODYwZNwlB28Ac_Ik-D2FBYsmI011udvxvoJecLZGc_1YhfdeMYlb9g9suGyKgtR6-o-2TBdqqJqBDsix4g7xrhkFXtIjqTQlWZabsiPLVJccYbRddSFwdtxtLOLgVo6OkQXrql34QttYd4DBDpBcrGPYXazQ2pDTz-v-W6GgPnVS_oBcPEz0iHFkc77SL1N10CnOC3-Vvzr-8_WIvQUl_QNVnxEHgzWIzy-O0_Ip9evPl68LS6v3mwvzi-LTpWaFY1qeiksqLqSbck6IbloG9WWSumqaZi0vG_5AErXHHhuBiEBoOyZlVooK0_I84N3SvHrAjib_L8OvLcB4oJGqDynqnnFM_rsH3QXlxTydkaUTAtZK1lm6vRAdSkiJhjMlNxo02o4MzfBmJtgzG0wGX56p1zaEfq_6J8kMsAPwN55WP-jMu-utu8P0t9syJuB</recordid><startdate>202104</startdate><enddate>202104</enddate><creator>Muñoz Aguilera, E.</creator><creator>Leira, Y.</creator><creator>Miró Catalina, Q.</creator><creator>Orlandi, M.</creator><creator>Czesnikiewicz‐Guzik, M.</creator><creator>Guzik, T. J.</creator><creator>Hingorani, A. D.</creator><creator>Nart, J.</creator><creator>D’Aiuto, F.</creator><general>Blackwell Publishing Ltd</general><scope>24P</scope><scope>WIN</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>C1K</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7444-1373</orcidid><orcidid>https://orcid.org/0000-0001-8365-0081</orcidid><orcidid>https://orcid.org/0000-0002-2363-4992</orcidid><orcidid>https://orcid.org/0000-0002-1173-3029</orcidid><orcidid>https://orcid.org/0000-0001-7379-4671</orcidid><orcidid>https://orcid.org/0000-0001-8654-935X</orcidid><orcidid>https://orcid.org/0000-0001-5027-7276</orcidid><orcidid>https://orcid.org/0000-0002-5039-7849</orcidid><orcidid>https://orcid.org/0000-0002-2225-5624</orcidid></search><sort><creationdate>202104</creationdate><title>Is systemic inflammation a missing link between periodontitis and hypertension? Results from two large population‐based surveys</title><author>Muñoz Aguilera, E. ; Leira, Y. ; Miró Catalina, Q. ; Orlandi, M. ; Czesnikiewicz‐Guzik, M. ; Guzik, T. J. ; Hingorani, A. D. ; Nart, J. ; D’Aiuto, F.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4590-848d32ae4763b50c2312b84b544968803a1db1fe4971e1a1df23eee5d0a3924a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Antihypertensives</topic><topic>Blood pressure</topic><topic>C-Reactive Protein - analysis</topic><topic>Creatinine</topic><topic>Cross-Sectional Studies</topic><topic>CRP</topic><topic>Gum disease</topic><topic>high blood pressure</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Hypertension - epidemiology</topic><topic>Inflammation</topic><topic>Inflammation - epidemiology</topic><topic>leucocytes</topic><topic>Leukocytes</topic><topic>Nutrition Surveys</topic><topic>Periodontitis</topic><topic>Periodontitis - epidemiology</topic><topic>Physical activity</topic><topic>Polls & surveys</topic><topic>Populations</topic><topic>Regression analysis</topic><topic>Regression models</topic><topic>Republic of Korea - epidemiology</topic><topic>systemic inflammation</topic><topic>United States - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Muñoz Aguilera, E.</creatorcontrib><creatorcontrib>Leira, Y.</creatorcontrib><creatorcontrib>Miró Catalina, Q.</creatorcontrib><creatorcontrib>Orlandi, M.</creatorcontrib><creatorcontrib>Czesnikiewicz‐Guzik, M.</creatorcontrib><creatorcontrib>Guzik, T. J.</creatorcontrib><creatorcontrib>Hingorani, A. D.</creatorcontrib><creatorcontrib>Nart, J.</creatorcontrib><creatorcontrib>D’Aiuto, F.</creatorcontrib><collection>Wiley Online Library Open Access</collection><collection>Wiley-Blackwell Open Access Backfiles</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of internal medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Muñoz Aguilera, E.</au><au>Leira, Y.</au><au>Miró Catalina, Q.</au><au>Orlandi, M.</au><au>Czesnikiewicz‐Guzik, M.</au><au>Guzik, T. J.</au><au>Hingorani, A. D.</au><au>Nart, J.</au><au>D’Aiuto, F.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Is systemic inflammation a missing link between periodontitis and hypertension? Results from two large population‐based surveys</atitle><jtitle>Journal of internal medicine</jtitle><addtitle>J Intern Med</addtitle><date>2021-04</date><risdate>2021</risdate><volume>289</volume><issue>4</issue><spage>532</spage><epage>546</epage><pages>532-546</pages><issn>0954-6820</issn><eissn>1365-2796</eissn><abstract><![CDATA[Objective
The primary objective was to investigate the relationship between periodontitis and hypertension in two independent large surveys. The secondary objective was to ascertain whether systemic inflammation had a mediation effect in the association.
Methods
This cross‐sectional study analysed representative samples of the US (n = 3460; NHANES 2009/10) and Korean (n = 4539; 2015 KNHANES VI‐3) populations. The association between periodontitis (exposure), hypertension (outcome) and inflammatory markers [C‐reactive protein (CRP) and white blood cell counts (WBC)] (mediators) was assessed using multivariate linear and logistic regression models and mediation analysis.
Results
Participants with periodontitis were more likely to have hypertension (NHANES: OR = 1.3, 95% CI: 1.0–1.6, P = 0.025; KNHANES: OR = 1.2, 95% CI: 1.0–1.4, P = 0.041) and actual systolic blood pressure ≥ 140 mmHg (NHANES: OR = 1.6, 95% CI: 1.1–2.3, P < 0.001; KNHANES: OR = 1.3, 95% CI :1.0–1.6, P < 0.031) than those without the disease. These associations were independent of age, gender, BMI, education level, smoking, alcohol consumption, creatinine, physical activity, presence of other comorbidities and confirmed in participants not taking antihypertensive medications. Diagnosis of periodontitis was directly associated with WBC (in both surveys: NHANES: β ± SE = 0.3 ± 0.1, P < 0.004; KNHANES: β ± SE = 0.3 ± 0.1, P < 0.001) and with CRP levels (in one survey: NHANES: β ± SE = 0.1 ± 0.03, P < 0.007; KNHANES: β ± SE = 0.1 ± 0.04, P > 0.213). Mediation analyses confirmed that CRP acted as a mediator in the association between periodontitis and hypertension in both populations (mediated effect: NHANES: β ± SE = 0.010 ± 0.003, P < 0.001; KNHANES: β ± SE = 0.003 ± 0.001, P = 0.015). WBC acted as a mediator in the KNHANES (mediated effect: β ± SE = 0.004 ± 0.001, P = 0.004) whilst in the NHANES, its effect was dependent of CRP inclusion in the model (mediated effect WBC + CRP: β ± SE = 0.002 ± 0.001, P = 0.001).
Conclusions
These findings suggest that periodontitis is closely linked to hypertension and systemic inflammation is, in part, a mediator of this association.]]></abstract><cop>England</cop><pub>Blackwell Publishing Ltd</pub><pmid>32969093</pmid><doi>10.1111/joim.13180</doi><tpages>14</tpages><orcidid>https://orcid.org/0000-0002-7444-1373</orcidid><orcidid>https://orcid.org/0000-0001-8365-0081</orcidid><orcidid>https://orcid.org/0000-0002-2363-4992</orcidid><orcidid>https://orcid.org/0000-0002-1173-3029</orcidid><orcidid>https://orcid.org/0000-0001-7379-4671</orcidid><orcidid>https://orcid.org/0000-0001-8654-935X</orcidid><orcidid>https://orcid.org/0000-0001-5027-7276</orcidid><orcidid>https://orcid.org/0000-0002-5039-7849</orcidid><orcidid>https://orcid.org/0000-0002-2225-5624</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of internal medicine, 2021-04, Vol.289 (4), p.532-546 |
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| language | eng |
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| source | Wiley-Blackwell Open Access Backfiles; MEDLINE; Access via Wiley Online Library; EZB Electronic Journals Library |
| subjects | Antihypertensives Blood pressure C-Reactive Protein - analysis Creatinine Cross-Sectional Studies CRP Gum disease high blood pressure Humans Hypertension Hypertension - epidemiology Inflammation Inflammation - epidemiology leucocytes Leukocytes Nutrition Surveys Periodontitis Periodontitis - epidemiology Physical activity Polls & surveys Populations Regression analysis Regression models Republic of Korea - epidemiology systemic inflammation United States - epidemiology |
| title | Is systemic inflammation a missing link between periodontitis and hypertension? Results from two large population‐based surveys |
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