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Health & Fitness

How oral health influences blood pressure treatment

Only 36 per cent of Kenyans who clean their teeth do so twice. FILE PHOTO | NMG
Only 36 per cent of Kenyans who clean their teeth do so twice. FILE PHOTO | NMG 

Oral hygiene is an integral part of wellbeing. Many try to adhere to recommended practices such as brushing teeth after meals so as to avert dental conditions like cavities and painful gums.

There are also many people who keep their mouths and teeth clean for grooming purposes. This is due to the fact that bad breath is an embarrassment.

But there is more to good oral hygiene than most people are unaware of, especially among patients with non-communicable diseases such as hypertension or high blood pressure.

In a recent study, researchers found that people with hypertension are less likely to fully benefit from their blood pressure lowering drugs if they have bad oral health.

Findings of the study, which was published in the American Heart Association’s Hypertension Journal, revealed that patients with healthier gums have lower blood pressure and respond better to medications, compared with individuals who have periodontitis (a gum disease).

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The researchers arrived at the conclusion after reviewing medical and dental examination records of more than 3,600 people with high blood pressure.

The results showed that people with gum disease were 20 percent less likely to reach healthy blood pressure ranges, compared with patients in good oral health.

Based on these findings, the researchers note that patients with gum disease may require closer blood pressure monitoring, while those diagnosed with hypertension - or persistently elevated blood pressure - might benefit from a referral to the dentist. "Physicians should pay close attention to patients' oral health, particularly those receiving treatment for hypertension, and urge those with signs of gum disease to seek dental care," said Dr Davide Pietropaoli, lead author of the study from the University of L'Aquila in Italy.

"Likewise, dental health professionals should be aware that oral health is indispensable to overall physiological health, including cardiovascular status."

The target blood pressure range for people with hypertension is less than 130/80 mmHg, according to latest recommendations.

The upper figure, known as systolic pressure, indicates the pressure of blood against the walls of arteries. This is a major indicator of cardiovascular health including hypertension and heart disease.

In the study, patients with severe gum disease had a systolic pressure reading that was three numbers higher than those with good oral health.

While seemingly small, the researchers noted that the difference is similar to the reduction in blood pressure that can be achieved by reducing salt intake by six grammes daily (equal to a teaspoon of salt, or 2.4 grammes of sodium).

Among patients with untreated hypertension, the gap was much higher. Their systolic pressure was seven numbers higher than those with good oral health. Blood pressure medication narrowed the gap, down to three numbers, but did not completely eliminate the gap. This, according to the researchers, suggested that gum disease might interfere with the effectiveness of blood pressure treatment.

"Patients with high blood pressure and the clinicians who care for them should be aware that good oral health may be just as important in controlling the condition as are several lifestyle interventions known to help control blood pressure, such as a low-salt diet, regular exercise and weight control," Pietropaoli said.

While the study was not designed to clarify exactly how gum disease interferes with blood pressure treatment, the researchers noted that their results are consistent with previous research that links low-grade oral inflammation with blood vessel damage and cardiovascular disease risk.

Health guidelines recommend that people brush their teeth at least twice daily, and especially before going to bed. But most Kenyans are still off the mark. Government statistics from the 2015 Kenya Stepwise Survey for non-communicable diseases (NCDs) risk factors found that whereas 89 per cent of Kenyans clean their teeth once daily, only 36 per cent do so twice daily. These figures, according the report, decrease as age advances yet the older people get, the more vulnerable they become to NCDs such as hypertension.

These statistics are of great concern since more than half (56 percent) of Kenyans have never been assessed for raised blood pressure. Out of those tested and found to have hypertension, only 22 percent are on medication prescribed by a health worker.

A majority of individuals could thus be suffering from bad oral health and undiagnosed hypertension — a fatal combination of conditions that can exacerbate damage to critical body organs hence leading to strokes, heart attacks, heart disease, nerve damage, kidney failure and loss of sight.

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