07 Mar Oral Bacteria May Be Linked to Hypertension Risk in Post-Menopausal Women

MedicalResearch.com Interview with:

Dr. LaMonte

Michael J. LaMonte, PhD, MPH
Research Professor (epidemiology)
Department of Epidemiology and Environmental Health
School of Public Health and Health Professions
Women’s Health Initiative Northeast Regional Center
University at Buffalo – SUNY
Buffalo, NY 14214

MedicalResearch.com:  What is the background for this study?  What are the main findings?

Dr. LaMonte:  The rationale for this study was based on existing study results showing

• (1) oral bacteria are involved with conversion of dietary nitrate (e.g., from leafy greens and beets) to nitric oxide which is a chemical involved keeping arteries healthy and maintaining blood pressure;
• (2) rinsing the mouth with antiseptic solution (mouthwash) kills oral bacteria and results in rapid increases in systolic and diastolic blood pressure; and
• (3) a very limited amount of epidemiological data suggest that the oral bacteria found beneath the gums (responsible for gingivitis and periodontal disease) are associated with blood pressure and history of hypertension in middle-aged adults.

Thus, we conducted our study to determine whether oral bacteria (beneath the gums) would be predictive of developing hypertension among women who were without this condition at the time the bacteria were measured. Because the bacteria (exposure) would be known to precede development of hypertension (disease), an association seen in our study would be strongly suggestive of a role for oral bacteria in the development of high blood pressure.

Our primary result was for statistically significant higher risks of developing hypertension associated with 10 bacterial species, and significantly lower risks of developing hypertension associated with 5 bacterial species. Our findings were evident even after we accounted for differences in demographic factors, lifestyle factors, and clinical factors, and generally were of consistent magnitudes we examined across subgroups of older and younger women, white and black women, normal weight and overweight/obese women, those with normal or slightly elevated blood pressure at study enrollment, and those who were using or not using menopausal hormone therapy at baseline. Therefore, while our observational study evidence for an association is not equivalent to causation, the robustness of the associations between oral bacteria and hypertension risk supports a need to further understand this relationship, ideally with a clinical trial design that would provide definitive evidence to support or refute causation. 

MedicalResearch.com: What should readers take away from your report?

Dr. LaMonte:  At the moment, our study is one of the only we know of that has examined oral bacteria in relationship to hypertension development in adults of any age, let alone older postmenopausal women (an understudied group in general). So, we need to be cautious to not overinterpret our study findings. There is a critical need for additional studies to evaluate the same fundamental question but in different populations to determine whether our result is consistent with those of other investigations. That said, if we assume there is a true relationship between oral bacteria and blood pressure health, then maintaining good oral hygiene and having routine preventive dental examinations and cleanings  as we age would be critical to keeping one’s risk for developing hypertension as low as possible. Not smoking, eating a sensible diet low in sugar-sweetened foods and drinks, and maintaining a healthy body weight also are important measures for healthy gums and oral well-being. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Dr. LaMonte:  As I mentioned above, we need evidence from two streams of investigation.

• First, we need additional prospective epidemiological studies to carefully measure the subgingival microbiome (bacterial communities) using state-of-the-art sequencing methods in women and men who are without diagnosed treated hypertension, and then follow these individuals over time for hypertension development. We need to know if our current study results are replicable by other investigators in other populations. Availability of repeat measures of oral bacteria would be especially helpful so that change in the oral microbiome could be studied in relation to subsequent development of hypertension. This would provide even stronger observational results than what we report based on a single measure of oral bacteria.
• Second, if observation studies consistently suggested a relationship exists between oral bacteria and blood pressure, we then would need to strongly consider the ethics and feasibility of a large scale randomized trial wherein adults with existing hypertension had their mouths treated with bacteriostatic agent – and perhaps additionally with a probiotic to target growth of good bacteria – and then hypertension risk would be compared between this treatment group and a control group that had hypertension but no oral bacteria intervention. The hypothesis would be that treating the oral bacteria would results in lowering blood pressure if, in fact, the bacteria were causally related to elevated pressures. We are a long way from justification for such a trial, but that certainly would be an eventual  destination needed to fully determine whether oral bacteria cause blood pressure dysregulation and hypertension in adults.

Citation:

Oral Microbiome Is Associated With Incident Hypertension Among Postmenopausal Women

Michael J. LaMonte PhD, MPH [email protected] , Joshua H. Gordon MD, PhD , Patricia Diaz‐Moreno DDS, PhD , Christopher A. Andrews PhD , Daichi Shimbo MD , Kathleen M. Hovey MS , Michael J. Buck PhD , and J. Wactawski‐Wende PhD
2 Mar 2022
https://doi.org/10.1161/JAHA.121.021930
Journal of the American Heart Association. 2022;0:e021930

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Last Updated on March 7, 2022 by Marie Benz