Sex differences in associations of periodontitis with blood pressure and arterial stiffening: the Hordaland Health Study.

OBJECTIVES: Periodontitis may promote chronic systemic inflammation leading to elevation of blood pressure (BP) and arterial stiffening. We explored sex-specific associations of periodontitis severity and inflammation with BP and arterial stiffness. METHODS: BP and arterial stiffness by carotid-femoral pulse wave velocity (cf-PWV) were measured in 673 women and 565 men, mean age 68 years. Periodontitis was staged using the European Federation of Periodontology/American Academy of Periodontology 2018 classification. Periodontal inflammation was assessed by full-mouth registration of bleeding on probing (BoP) and number of sites with combined probing pocket-depth (PPD) ≥ 4 mm and BoP. The associations of periodontitis severity and periodontal inflammation with BP and arterial stiffness were tested in sex-specific linear/logistic regression analyses, adjusted for diabetes, smoking, BMI, education, and antihypertensive treatment. RESULTS: Men had higher BP and cf-PWV than women (both P < 0.01). Stage II (moderate) and III/IV (advanced) periodontitis were found in 24 and 76% of women and 18 and 82% of men (P = 0.03). Mean BoP was 55 in both genders (P = 0.91). In adjusted analysis, stage III/IV (advanced) periodontitis was associated with higher SBP and DBP in women only (β = 0.08 and β = 0.09, both P < 0.05). BoP was associated with higher DBP only in women (β = 0.12) (P for sex interaction < 0.05) and with higher cf-PWV in men (β = 0.09) (both P < 0.05). PPD ≥ 4 mm with BoP was associated with increased arterial stiffness in women (P = 0.03). CONCLUSION: Advanced periodontitis and periodontal inflammation were both associated with higher BP only in women, while periodontal inflammation was associated with increased arterial stiffness in both genders.