Is there a connection between sublingual varices and hypertension?

Abstract

BackgroundSublingual varices have earlier been related to ageing, smoking and cardiovascular disease. The aim of this study was to investigate whether sublingual varices are related to presence of hypertension.MethodsIn an observational clinical study among 431 dental patients tongue status and blood pressure were documented. Digital photographs of the lateral borders of the tongue for grading of sublingual varices were taken, and blood pressure was measured. Those patients without previous diagnosis of hypertension and with a noted blood pressure ≥ 140 mmHg and/or ≥ 90 mmHg at the dental clinic performed complementary home blood pressure during one week. Those with an average home blood pressure ≥135 mmHg and/or ≥85 mmHg were referred to the primary health care centre, where three office blood pressure measurements were taken with one week intervals. Two independent blinded observers studied the photographs of the tongues. Each photograph was graded as none/few (grade 0) or medium/severe (grade 1) presence of sublingual varices. Pearson’s Chi-square test, Student’s t-test, and multiple regression analysis were applied. Power calculation stipulated a study population of 323 patients.ResultsAn association between sublingual varices and hypertension was found (OR = 2.25, p < 0.002). Mean systolic blood pressure was 123 and 132 mmHg in patients with grade 0 and grade 1 sublingual varices, respectively (p < 0.0001, CI 95 %). Mean diastolic blood pressure was 80 and 83 mmHg in patients with grade 0 and grade 1 sublingual varices, respectively (p < 0.005, CI 95 %). Sublingual varices indicate hypertension with a positive predictive value of 0.5 and a negative predictive value of 0.80.ConclusionsAn association was found between sublingual varices and hypertension. Examining the lateral borders of the tongue is easily done, causes no harm and could be a valuable method for the dental profession to take active part in preventive healthcare.

Evaluation of the factors associated with sublingual varices: a descriptive clinical study

“…However, aging has less influence on development of SV (OR: 1.08, p < 0.001). This finding is consistent with the previous study reported that SV may be used as an indicator of hypertension (OR: 2.25, p = 0.021) [11]. Lynge Pedersen et al [19] found a relationship between SV and CVD and medication.…”

“…Intra-observer reliability was found 0.91. Hedström et al [11] reported 0.87 inter-observer agreement using the same diagnostic criteria. These intra-and inter-observer values shows that reproducibility and repeatability of the classification system is satisfactory.…”

“…Kleinman [16] stated that the condition is related to the aging process, and prior to the fifth decade, varices may be an indication of premature aging. Chronic cough [3], venous insufficiency [8], cardiovascular/cardiopulmonary diseases [11,12,19], portal hypertension [14], diabetes mellitus [29], chronic vitamin C deficiency [2], smoking [12], denture wearing [1] have been suggested as predisposing factors for SV. There are limited number of studies which have been examined the association between SV and conditions listed above [1-3, 8, 11, 12, 16, 19].…”

“…Lynge Pedersen et al [19] found an association between sublingual varicosities and cardiovascular diseases (CVD) and medication. Recently, Hedström et al [11] found an association between SV and hypertension; Al-Shayyab and Baqain [1] described that old age, female gender, denture wearing and CVD are the risk factors for SV. These results arises a question whether cardiovascular system diseases as a whole or only hypertensive disease is related to SV.…”

A bleeding vallecular varix, visualized by GI endoscopy, confirmed with CT angiography, and treated with sclerotherapy and cyanoacrylate

“…Sublingual varices have been described commonly in patients with cardiovascular disease and smoking 3 , 4 ; however, the pathogenesis of vallecular varices is poorly understood and believed to be secondary to chronic coughing resulting from respiratory conditions such as bronchitis and tuberculosis. 5 , 6 , 7 Only 1 case of base-of-the-tongue varices in a patient with portal hypertension due to liver cirrhosis has been reported.…”