Periodontal inflammation mediates the link between homocysteine and high blood pressure

Abstract

Background: Here, we assess the association between Hcy serum levels and periodontal status in a large representative sample of the National Health and Nutrition Examination Survey (NHANES). Methods: We included 4,021 participants with a periodontal examination, medical self-reported data, BP and blood samples to determine complete blood count, C-reactive protein (CRP) and Hcy levels. We then calculated the periodontal inflamed surface area (PISA) and the periodontal epithelial surface area (PESA). Multivariable regression analysis explored the association between Hcy, periodontal measures and blood pressure. Mediation analysis was performed to understand the effect of age on the association of periodontitis with BP. Mediation analysis assessed the effect of PISA and PESA in the link between Hcy and BP. Results: 4,021 participants fulfilled the inclusion criteria. Hcy levels showed significant correlations with systolic BP, diastolic BP, PISA, PESA and age. PESA showed to be significantly associated with Hcy both for the crude and adjusted models (p<0.01), but not PISA (p>0.05). In the association of Hcy with systolic BP, PISA significantly mediated 17.4% and PESA 0.9%. In the association of Hcy with diastolic BP, PISA significantly mediated 16.3% and PESA 47.2%. Conclusions: This report shows that Hcy and periodontitis are associated. Also, both PISA and PESA significantly mediated the association of Hcy with systolic BP and diastolic BP. Future studies shall deepen the mechanisms by which homocysteine levels increase in a clinical situation of periodontitis.