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      Periodontitis is associated with hypertension: a systematic review and meta-analysis.

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          Abstract

          Recent evidence suggests a link between periodontitis (PD) and hypertension, but the nature of this association remains unclear. The overall aim of this review was to critically appraise the evidence linking these two common disorders. Systematic search was conducted for studies published up to December 2018. Prevalence of hypertension in patients with PD (moderate/severe groups) vs. those without PD (non-PD) was the primary outcome. Additional outcomes included adjusted mean difference in systolic (SBP) and diastolic (DBP) blood pressure (BP) levels in PD vs. non-PD, assessment of biomarkers in PD and hypertension, and BP changes after periodontal therapy. From 81 studies selected, 40 were included in quantitative meta-analyses. Diagnoses of moderate-severe PD [odds ratio (OR) = 1.22; 95% confidence interval (CI): 1.10-1.35] and severe PD (OR = 1.49; 95% CI: 1.09-2.05) were associated with hypertension. Prospective studies confirmed PD diagnosis increased likelihood of hypertension occurrence (OR = 1.68; 95% CI: 0.85-3.35). Patients with PD exhibited higher mean SBP [weighted mean difference (WMD) of 4.49 mmHg; 95% CI: 2.88-6.11] and DBP (2.03 mmHg; 95% CI: 1.25-2.81) when compared with non-PD. Lastly, only 5 out of 12 interventional studies confirmed a reduction in BP following periodontal therapy, ranging from 3 to 12.5 mmHg of SBP and from 0 to 10 mmHg of DBP. PD is associated with increased odds of hypertension (SORT C) and higher SBP/DBP levels. The evidence suggesting that PD therapy could reduce BP is inconclusive. Although additional research is warranted on this association, these results suggest that oral health assessment and management of PD could not only improve oral/overall health and quality of life but also be of relevance in the management of patients with hypertension.

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          Most cited references78

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          Bias in meta-analysis detected by a simple, graphical test

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            Is Open Access

            ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions

            Non-randomised studies of the effects of interventions are critical to many areas of healthcare evaluation, but their results may be biased. It is therefore important to understand and appraise their strengths and weaknesses. We developed ROBINS-I (“Risk Of Bias In Non-randomised Studies - of Interventions”), a new tool for evaluating risk of bias in estimates of the comparative effectiveness (harm or benefit) of interventions from studies that did not use randomisation to allocate units (individuals or clusters of individuals) to comparison groups. The tool will be particularly useful to those undertaking systematic reviews that include non-randomised studies.
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              Operating Characteristics of a Rank Correlation Test for Publication Bias

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                Author and article information

                Journal
                Cardiovasc. Res.
                Cardiovascular research
                Oxford University Press (OUP)
                1755-3245
                0008-6363
                January 01 2020
                : 116
                : 1
                Affiliations
                [1 ] Periodontology Unit, University College London Eastman Dental Institute, London WC1X 8LD, UK.
                [2 ] Department of Periodontology, Faculty of Dentistry, Universitat Internacional de Catalonia, Sant Cugat del Vallès, Barcelona 08195, Spain.
                [3 ] Department of Periodontology and Oral Sciences Research Group, University of Glasgow Dental School, Glasgow G12 8QQ, UK.
                [4 ] Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8QQ, UK.
                [5 ] Department of Experimental Dentistry and Dental Prophylaxis, Jagiellonian University, Krakow, Poland.
                [6 ] Department of Internal and Agricultural Medicine, Jagiellonian University, Krakow, Poland.
                [7 ] Department of Physiology, Ribeirao Preto Medical School, University of Sao Paulo, Sao Paulo, Brazil.
                [8 ] Genetic Epidemiology, Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London WC1E 6BT, UK.
                Article
                5572510
                10.1093/cvr/cvz201
                31549149
                16aee7f5-e729-4445-9900-2e468577ea99
                History

                Blood pressure,Periodontitis, Periodontal therapy,Periodontal diseases,Hypertension,Oral health,Inflammation

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