title: Periodontal disease and incidence of hypertension in the health professionals follow-up study.
abstract: BACKGROUND
  Recent studies suggest a possible association between periodontal disease and hypertension; however, prospective evidence is limited.
  
  
  METHODS
  The study population consisted of 31,543 participants of the Health Professionals' Follow-Up Study (HPFS) prospective cohort who were 40-75 years old at baseline, had no prior hypertension history and had complete baseline information on oral health. Information on periodontal disease, hypertension and potential confounders was updated biennially. We used Cox proportional hazards models to study the relation between periodontal disease at baseline, during follow-up, periodontal bone loss severity, baseline number of teeth, and tooth loss during follow-up, and the risk of developing hypertension. Multivariate models included age, calendar time, race, comprehensive smoking index (CSI), diabetes, alcohol consumption, family history of hypertension, dental profession, body mass index (BMI), physical activity, fruit and vegetable intake, multivitamin use, calcium, vitamin D and vitamin E intake.
  
  
  RESULTS
  We identified 10,828 cases of incident hypertension over 20 years of follow-up. After adjusting for potential confounders, we did not observe significant associations between incident hypertension and periodontal disease at baseline (relative risk (RR) = 1.04; 95% confidence interval (CI): 0.98-1.10), periodontitis during follow-up (RR = 1.01; 95% CI: 0.96-1.05), tooth loss during follow-up (RR = 1.03; 95% CI: 0.98-1.09), or when comparing men with 0-10 teeth to men with ≥ 25 teeth at baseline (RR = 1.05; 95% CI: 0.91-1.21). Participants reporting severe periodontal bone loss had a RR for incident hypertension of 1.02 compared to those without bone loss (95% CI: 0.77-1.35).
  
  
  CONCLUSIONS
  We did not observe an association between periodontal disease measures and incident hypertension in this cohort of middle-aged men.
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA. sona.tumanyan@upr.edu
authors.forename: Sona
authors.initials: S
authors.lastname: Rivas-Tumanyan
authors.forename: Donna
authors.initials: D
authors.lastname: Spiegelman
authors.forename: Gary C
authors.initials: GC
authors.lastname: Curhan
authors.forename: John P
authors.initials: JP
authors.lastname: Forman
authors.forename: Kaumudi J
authors.initials: KJ
authors.lastname: Joshipura
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005500:Follow-Up Studies; D006282:Health Personnel; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000209:etiology*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010510:Periodontal Diseases / Q000150:complications* / Q000453:epidemiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D016388:Tooth Loss / Q000150:complications* / Q000453:epidemiology; D014481:United States / Q000453:epidemiology