Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Arterial stiffness in periodontitis patients and controls

A case–control and pilot intervention study

Journal of Human Hypertension volume 30, pages 24–29 (2016)Cite this article

Subjects

Abstract

Increased arterial stiffness (AS) is an important indicator for atherosclerotic cardiovascular disease (ACVD). Epidemiologically, periodontitis and ACVD are associated. Therefore, we aimed to investigate AS in periodontitis patients and controls. In addition, we explored the effect of periodontal therapy on AS in a sub-group of cases. Pulse-wave velocity (PWV), a non-invasive chair-side function test for AS, was measured in periodontitis patients (n=57; mean age 46.6 years) and compared with a reference group (n=48; mean age 45.5 years). In addition, 45 cases (mean age 46.9 years) were 6 months followed after periodontal treatment, to explore a possible effect on arterial function. Periodontitis patients showed a significantly increased PWV compared with the reference group (8.01±0.20 vs 7.36±0.22 m s−1 respectively; P=0.029) and this remained significant after adjustments for ACVD risk factors (P=0.019). After periodontal therapy, no significant reduction in PWV was seen (8.00±1.8 to 7.82±1.6 m s−1; P=0.13), but systolic blood pressure (SBP) was significantly reduced (119.8±14.6 to 116.9±15.1 mm Hg; P=0.040). It can be concluded that periodontitis is associated with increased AS. This confirms with a new parameter the association of periodontitis with ACVD. Although periodontal treatment did not lower AS significantly, a modest reduction of SBP after 6 months was observed.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. Lockhart PB, Bolger AF, Papapanou PN, Osinbowale O, Trevisan M, Levison ME et al. Periodontal disease and atherosclerotic vascular disease: does the evidence support an independent association? A scientific statement from the American Heart Association. Circulation 2012; 125 (20): 2520–2544.

    Article  Google Scholar 

  2. Pihlstrom BL, Michalowicz BS, Johnson NW . Periodontal diseases. Lancet 2005; 366 (9499): 1809–1820.

    Article  Google Scholar 

  3. Eke PI, Dye BA, Wei L, Thornton-Evans GO, Genco RJ . CDC Periodontal Disease Surveillance Workgroup: James Beck GDRP. Prevalence of periodontitis in adults in the United States: 2009 and 2010. J Dent Res 2012; 91 (10): 914–920.

    Article  CAS  Google Scholar 

  4. Hugoson A, Sjodin B, Norderyd O . Trends over 30 years, 1973-2003, in the prevalence and severity of periodontal disease. J Clin Periodontol 2008; 35 (5): 405–414.

    Article  Google Scholar 

  5. Schenkein HA, Loos BG . Inflammatory mechanisms linking periodontal diseases to cardiovascular diseases. J Clin Periodontol 2013; 40 (Suppl 14): S51–S69.

    PubMed  PubMed Central  Google Scholar 

  6. Teeuw WJ, Slot DE, Susanto H, Gerdes VE, Abbas F, D'Aiuto F et al. Treatment of periodontitis improves the atherosclerotic profile: a systematic review and meta-analysis. J Clin Periodontol 2014; 41 (1): 70–79.

    Article  CAS  Google Scholar 

  7. Graham I, Atar D, Borch-Johnsen K, Boysen G, Burell G, Cifkova R et al. European guidelines on cardiovascular disease prevention in clinical practice: full text. Fourth Joint Task Force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts). Eur J Cardiovasc Prev Rehabil 2007; 14 (Suppl 2): S1–S113.

    Article  Google Scholar 

  8. Vlachopoulos C, Aznaouridis K, Stefanadis C . Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis. J Am Coll Cardiol 2010; 55 (13): 1318–1327.

    Article  Google Scholar 

  9. Miyaki K, Masaki K, Naito M, Naito T, Hoshi K, Hara A et al. Periodontal disease and atherosclerosis from the viewpoint of the relationship between community periodontal index of treatment needs and brachial-ankle pulse wave velocity. BMC Public Health 2006; 6: 131.

    Article  Google Scholar 

  10. Franek E, Blaschyk R, Kolonko A, Mazur-Psonka L, Langowska-Adamczyk H, Kokot F et al. Chronic periodontitis in hemodialysis patients with chronic kidney disease is associated with elevated serum C-reactive protein concentration and greater intima-media thickness of the carotid artery. J Nephrol 2006; 19 (3): 346–351.

    CAS  PubMed  Google Scholar 

  11. Franek E, Januszkiewicz-Caulier J, Blach A, Napora M, Jedynasty K, Budlewski T et al. Intima-media thickness and other markers of atherosclerosis in patients with type 2 diabetes and periodontal disease. Kardiol Pol 2012; 70 (1): 7–13.

    PubMed  Google Scholar 

  12. Franek E, Klamczynska E, Ganowicz E, Blach A, Budlewski T, Gorska R et al. Association of chronic periodontitis with left ventricular mass and central blood pressure in treated patients with essential hypertension. Am J Hypertens 2009; 22 (2): 203–207.

    Article  Google Scholar 

  13. Vieira CL, Cury PR, Miname MH, Martinez LR, Bortolotto LA, Giuliano IB et al. Severe periodontitis is associated with diastolic blood pressure elevation in individuals with heterozygous familial hypercholesterolemia: a pilot study. J Periodontol 2011; 82 (5): 683–688.

    Article  CAS  Google Scholar 

  14. Vidal F, Cordovil I, Figueredo CM, Fischer RG . Non-surgical periodontal treatment reduces cardiovascular risk in refractory hypertensive patients: a pilot study. J Clin Periodontol 2013; 40 (7): 681–687.

    Article  CAS  Google Scholar 

  15. Mulders TA, van den Bogaard B, Bakker A, Trip MD, Stroes ES, van den Born BJ et al. Arterial stiffness is increased in families with premature coronary artery disease. Heart 2012; 98 (6): 490–494.

    Article  CAS  Google Scholar 

  16. Tonetti MS, Claffey N . European Workshop in Periodontology group C. Advances in the progression of periodontitis and proposal of definitions of a periodontitis case and disease progression for use in risk factor research. Group C consensus report of the 5th European Workshop in Periodontology. J Clin Periodontol 2005; 32 (Suppl 6): 210–213.

    Article  Google Scholar 

  17. National Cholesterol Education Program Expert Panel on Detection E, Treatment of High Blood Cholesterol in A. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002; 106 (25): 3143–3421.

    Article  Google Scholar 

  18. Wilson PW, Castelli WP, Kannel WB . Coronary risk prediction in adults (the Framingham Heart Study). Am J Cardiol 1987; 59 (14): 91G–94G.

    Article  CAS  Google Scholar 

  19. Winkel EG, Van Winkelhoff AJ, Timmerman MF, Van der Velden U, Van der Weijden GA . Amoxicillin plus metronidazole in the treatment of adult periodontitis patients. A double-blind placebo-controlled study. J Clin Periodontol 2001; 28 (4): 296–305.

    Article  CAS  Google Scholar 

  20. Hanaoka Y, Soejima H, Yasuda O, Nakayama H, Nagata M, Matsuo K et al. Level of serum antibody against a periodontal pathogen is associated with atherosclerosis and hypertension. Hypertens Res 2013; 36 (9): 829–833.

    Article  CAS  Google Scholar 

  21. Jockel-Schneider Y, Harks I, Haubitz I, Fickl S, Eigenthaler M, Schlagenhauf U et al. Arterial stiffness and pulse wave reflection are increased in patients suffering from severe periodontitis. PloS one 2014; 9 (8): e103449.

    Article  Google Scholar 

  22. Kapellas K, Jamieson LM, Do LG, Bartold PM, Wang H, Maple-Brown LJ et al. Associations between periodontal disease and cardiovascular surrogate measures among Indigenous Australians. Int J Cardiol 2014; 173 (2): 190–196.

    Article  Google Scholar 

  23. Shanker J, Setty P, Arvind P, Nair J, Bhasker D, Balakrishna G et al. Relationship between periodontal disease, Porphyromonas gingivalis, peripheral vascular resistance markers and coronary artery disease in Asian Indians. Thromb Res 2013; 132 (1): e8–14.

    Article  CAS  Google Scholar 

  24. Schillaci G, Bilo G, Pucci G, Laurent S, Macquin-Mavier I, Boutouyrie P et al. Relationship between short-term blood pressure variability and large-artery stiffness in human hypertension: findings from 2 large databases. Hypertension 2012; 60 (2): 369–377.

    Article  CAS  Google Scholar 

  25. Vlachopoulos C, Dima I, Aznaouridis K, Vasiliadou C, Ioakeimidis N, Aggeli C et al. Acute systemic inflammation increases arterial stiffness and decreases wave reflections in healthy individuals. Circulation 2005; 112 (14): 2193–2200.

    Article  Google Scholar 

  26. Franklin SS, Gustin Wt, Wong ND, Larson MG, Weber MA, Kannel WB et al. Hemodynamic patterns of age-related changes in blood pressure. The Framingham Heart Study. Circulation 1997; 96 (1): 308–315.

    Article  CAS  Google Scholar 

  27. Cecelja M, Chowienczyk P . Arterial stiffening: cause and prevention. Hypertension 2010; 56 (1): 29–30.

    Article  CAS  Google Scholar 

  28. Hansen TW, Li Y, Staessen JA, Jeppesen J, Rasmussen S, Wang JG et al. Independent prognostic value of the ambulatory arterial stiffness index and aortic pulse wave velocity in a general population. J Hum Hypertens 2008; 22 (3): 214–216.

    Article  CAS  Google Scholar 

  29. Tonetti MS, D'Aiuto F, Nibali L, Donald A, Storry C, Parkar M et al. Treatment of periodontitis and endothelial function. N Engl J Med 2007; 356 (9): 911–920.

    Article  CAS  Google Scholar 

  30. Greenland P, Alpert JS, Beller GA, Benjamin EJ, Budoff MJ, Fayad ZA et al. 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2010; 122 (25): e584–e636.

    PubMed  Google Scholar 

  31. Han YW, Houcken W, Loos BG, Schenkein HA, Tezal M . Periodontal disease, atherosclerosis, adverse pregnancy outcomes, and head-and-neck cancer. Adv Dent Res 2014; 26 (1): 47–55.

    Article  CAS  Google Scholar 

  32. Piconi S, Trabattoni D, Luraghi C, Perilli E, Borelli M, Pacei M et al. Treatment of periodontal disease results in improvements in endothelial dysfunction and reduction of the carotid intima-media thickness. FASEB J 2009; 23 (4): 1196–1204.

    Article  CAS  Google Scholar 

  33. Seinost G, Wimmer G, Skerget M, Thaller E, Brodmann M, Gasser R et al. Periodontal treatment improves endothelial dysfunction in patients with severe periodontitis. Am Heart J 2005; 149 (6): 1050–1054.

    Article  Google Scholar 

  34. Kapellas K, Maple-Brown LJ, Jamieson LM, Do LG, O'Dea K, Brown A et al. Effect of periodontal therapy on arterial structure and function among aboriginal Australians: a randomized, controlled trial. Hypertension 2014; 64 (4): 702–708.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

This research has been supported in Part by a grant of the University of Amsterdam for the focal point 'Oral Health'. In addition, the pilot intervention has been supported in part by Philips Oral Healthcare.

Author information

Authors and Affiliations

  1. Department of Periodontology, Academic Centre of Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, Amsterdam, The Netherlands

    W Houcken, W J Teeuw, S Bizzarro, E Alvarez Rodriguez & B G Loos

  2. Department of Vascular Medicine, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam, The Netherlands

    T A Mulders & B-JH van den Born

Authors
  1. W Houcken
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. W J Teeuw
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S Bizzarro
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. E Alvarez Rodriguez
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. T A Mulders
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. B-JH van den Born
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. B G Loos
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to W J Teeuw.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Houcken, W., Teeuw, W., Bizzarro, S. et al. Arterial stiffness in periodontitis patients and controls. J Hum Hypertens 30, 24–29 (2016). https://doi.org/10.1038/jhh.2015.41

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jhh.2015.41

This article is cited by

Search

Advanced search

Quick links