Cochrane · intervention · CD009409
Effect of periodontal treatments on blood pressure
Luo, Y, Ye, H, Liu, W, et al. · Cochrane Database of Systematic Reviews · 2021 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
49
current version
GRADE rated
16
No studies
3
Included studies
8
as reported
No studies 3 · 6.1%Ungraded 30 · 61.2%Very low 5 · 10.2%Low 8 · 16.3%Moderate 3 · 6.1%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Men and women of any race, social and economic status meeting all of: at least five teeth remaining; diagnosed with periodontitis (PPD greater than 4 mm); with hypertension (BP greater than 140/90 mmHg) or without hypertension in trials focusing on preventive effects; no periodontal treatment in the past three months; not specific to participants with a history of any other systemic diseases, except for hypertension-related illness | 894 participants in eight RCTs: one study recruited people with hypertension and moderate-to-severe periodontitis; three studies severe and generalized periodontitis; two studies stable coronary heart disease and mild-to-moderate chronic periodontitis; one study chronic periodontitis with some reporting hypertension; one study prehypertension with moderate-to-severe periodontitis (n=894) |
| Intervention | Intervention group: subgingival SRP with or without any other type of periodontal treatment (supra-gingival scaling; SRP full-mouth or quadrant-wise; systemic or local antibiotic or host modulation treatment; periodontal surgery) | Periodontal treatment / subgingival SRP with or without other periodontal treatment (n=566); Intensive periodontal treatment (n=328) |
| Comparison | No treatment; Supra-gingival scaling; Alternative periodontal treatment | No treatment (n=566); Supra-gingival scaling (n=328) |
| Outcomes | Change in systolic and diastolic blood pressure (mmHg); Proportion of participants diagnosed with hypertension at trial completion; Proportion of participants with adverse events or withdrawing due to adverse events; Plasma levels of inflammatory markers (IL-6, C-reactive protein); Heart rate; Endothelial function; Periodontal clinical parameters (clinical attachment level (CAL), PPD, bleeding on probing (BOP)) | Change in SBP and DBP (n=894); Adverse events (n=894); Plasma levels of hs-CRP (n=622); Plasma levels of IL-6 (n=544); Heart rate (n=48); Endothelial function (n=376); Periodontal clinical parameters PPD CAL and BOP (n=381) |
| Study designs | RCTs and quasi-RCTs; cross-over studies excluded | Eight RCTs (seven two-arm parallel-group; D'Aiuto 2006 had three arms); five at low risk of bias, one unclear, two high; D'Aiuto 2006 excluded from the meta-analysis owing to flawed data (seven studies pooled) |
| Timing | All outcome variables recorded at least one month after treatment; short term defined as less than 6 months and long term as 6 months or greater | Short-term (less than 6 months) and long-term (6 months or greater) changes; follow-up ranged from 2 to 12 months |
Search date: 2020-11. Databases: Cochrane Hypertension Specialised Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE Ovid; Embase Ovid; CINAHL EBSCO; LILACS Bireme; US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov); WHO International Clinical Trials Registry Platform (ICTRP);…
Questions and results
Current version onlyPeriodontal treatment (subgingival SRP with or without other periodontal treatment) vs No treatment (no periodontal treatment)
Population: Adults (any age/sex) with chronic periodontitis (>=5 teeth remaining; PPD >4 mm), with or without hypertension
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Change in diastolic blood pressure (DBP, mmHg) Long term (follow-up 12 months) · People diagnosed with periodontitis | MD -0.2 [-3.02, 2.62] | 1 study · 168 participants | Low Downgraded: imprecision |
Plasma level of hs-CRP (mg/L) Long term · People diagnosed with periodontitis and other cardiovascular diseases except hypertension | MD -0.72 [-1.74, 0.30] | 2 studies · 103 participants | Ungraded |
Proportion of participants diagnosed with hypertension at trial completion | No included study reported the proportion of participants diagnosed with hypertension at trial completion. | NR | No studies |
Clinical attachment level (CAL) Long term · People diagnosed with periodontitis and other cardiovascular diseases except hypertension | MD -1.85 [-2.41, -1.29] | 1 study · 48 participants | Ungraded |
Pocket probing depth (PPD) Long term · People diagnosed with periodontitis and other cardiovascular diseases except hypertension | MD -1.94 [-2.35, -1.53] | 1 study · 48 participants | Ungraded |
Plasma level of hs-CRP (mg/L) Long term · People diagnosed with periodontitis | MD 1.19 [-0.55, 2.93] | 1 study · 168 participants | Ungraded |
Change in systolic blood pressure (SBP, mmHg) Long term (follow-up 12 months) · People diagnosed with periodontitis | MD 0.14 [-4.4, 4.68] | 1 study · 168 participants | Low Downgraded: imprecision |
Change in diastolic blood pressure (DBP, mmHg) Short term (follow-up 2-3 months) · People diagnosed with periodontitis | MD -0.15 [-2.47, 2.17] | 2 studies · 294 participants | Low Downgraded: imprecision, inconsistency |
Adverse events (participants with adverse events or withdrawals due to adverse events) | SoF 1 (Adverse effects): Only 1 study reported that 1 participant in the treatment group experienced a myocardial infarction during the study period. 1 study reported no adverse effects. The remaining 2 studies did not… | 2 studies · 294 participants | Low Downgraded: imprecision, inconsistency |
Change in systolic blood pressure (SBP, mmHg) Short term (follow-up 2-3 months) · People diagnosed with periodontitis | MD -0.14 [-4.05, 3.77] | 2 studies · 294 participants | Low Downgraded: imprecision, inconsistency |
Plasma level of hs-CRP (mg/L) Short term · People diagnosed with periodontitis and other cardiovascular diseases except hypertension | MD 0.65 [-1.23, 2.53] | 1 study · 55 participants | Ungraded |
Endothelial function (forearm blood flow) Long term · People diagnosed with periodontitis and other cardiovascular diseases except hypertension | MD 0.10 [-0.67, 0.87] | 1 study · 48 participants | Ungraded |
Plasma level of IL-6 (pg/mL) Short term · People diagnosed with periodontitis | MD -0.34 [-1.06, 0.38] | 1 study · 169 participants | Ungraded |
Change in systolic blood pressure (SBP, mmHg) Long term (follow-up 6 months) · People diagnosed with periodontitis and other cardiovascular diseases except hypertension | MD -2.25 [-9.41, 4.92] | 2 studies · 108 participants | Low Downgraded: risk of bias, imprecision |
Bleeding on probing (BOP) Long term · People diagnosed with periodontitis and other cardiovascular diseases except hypertension | MD -36.80 [-46.47, -27.13] | 1 study · 48 participants | Ungraded |
Change in diastolic blood pressure (DBP, mmHg) Short term (follow-up 3 months) · People diagnosed with periodontitis and other cardiovascular diseases except hypertension | MD -2.45 [-7.95, 3.05] | 1 study · 55 participants | Very low Downgraded: risk of bias, imprecision |
Change in diastolic blood pressure (DBP, mmHg) Long term (follow-up 6 months) · People diagnosed with periodontitis and other cardiovascular diseases except hypertension | MD -2.55 [-6.9, 1.8] | 2 studies · 103 participants | Low Downgraded: risk of bias, imprecision |
Heart rate Long term · People diagnosed with periodontitis and other cardiovascular diseases except hypertension | MD -0.70 [-6.06, 4.66] | 1 study · 48 participants | Ungraded |
Plasma level of hs-CRP (mg/L) Short term · People diagnosed with periodontitis | MD -0.18 [-0.42, 0.05] | 2 studies · 294 participants | Ungraded |
Plasma level of IL-6 (pg/mL) Long term · People diagnosed with periodontitis | MD -1.60 [-2.31, -0.89] | 1 study · 168 participants | Ungraded |
Change in systolic blood pressure (SBP, mmHg) Short term (follow-up 3 months) · People diagnosed with periodontitis and other cardiovascular diseases except hypertension | MD 0.59 [-9.18, 10.36] | 1 study · 55 participants | Very low Downgraded: risk of bias, imprecision |
Plasma level of IL-6 (pg/mL) Long term · People diagnosed with periodontitis and other cardiovascular diseases except hypertension | MD -0.90 [-2.97, 1.17] | 1 study · 48 participants | Ungraded |
Intensive periodontal treatment (subgingival SRP with or without other periodontal treatment) vs Supra-gingival scaling
Population: Adults (any age/sex) with chronic periodontitis (>=5 teeth remaining; PPD >4 mm), with or without hypertension
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Endothelial function (flow-mediated dilation) Long term · People diagnosed with periodontitis | MD 1.48 [0.67, 2.29] | 1 study · 120 participants | Ungraded |
Change in diastolic blood pressure (DBP, mmHg) Short term (follow-up 2-3 months) · People diagnosed with periodontitis | MD -2.08 [-4.84, 0.68] | 2 studies · 227 participants | Low Downgraded: imprecision, inconsistency |
Plasma level of IL-6 (pg/mL) Short term · People diagnosed with periodontitis and hypertension | MD -6.00 [-12.68, 0.68] | 1 study · 101 participants | Ungraded |
Endothelial function (flow-mediated dilation) Short term · People diagnosed with periodontitis | MD -0.25 [-1.30, 0.80] | 1 study | Ungraded |
Change in diastolic blood pressure (DBP, mmHg) Long term (follow-up 6 months) · People diagnosed with periodontitis | MD -4.96 [-13.04, 3.13] | 2 studies · 227 participants | Very low Downgraded: imprecision, inconsistency |
Clinical attachment level (CAL) Long term · People diagnosed with periodontitis | MD -9.38 [-15.85, -2.91] | 1 study | Ungraded |
Plasma level of hs-CRP (mg/L) Short term · People diagnosed with periodontitis | MD -0.37 [-1.40, 0.65] | 2 studies | Ungraded |
Heart rate | Heart rate was reported only by Higashi 2009 (periodontal treatment vs no treatment); no study in the intensive-treatment vs supra-gingival-scaling comparison reported heart rate. | NR | No studies |
Change in diastolic blood pressure (DBP, mmHg) Short term (follow-up 2 months) · People diagnosed with periodontitis and hypertension | MD -8.40 [-12.19, -4.61] | 1 study · 101 participants | Moderate Downgraded: imprecision |
Plasma level of hs-CRP (mg/L) Long term · People diagnosed with periodontitis | MD -0.16 [-2.15, 1.83] | 2 studies | Ungraded |
Proportion of participants diagnosed with hypertension at trial completion | No included study in this comparison reported the proportion of participants diagnosed with hypertension at trial completion. | NR | No studies |
Change in systolic blood pressure (SBP, mmHg) Short term (follow-up 2 months) · People diagnosed with periodontitis and hypertension | MD -11.2 [-15.4, -7.0] | 1 study · 101 participants | Moderate Downgraded: imprecision |
Pocket probing depth (PPD) Long term · People diagnosed with periodontitis | MD -18.90 [-26.34, -11.46] | 1 study | Ungraded |
Endothelial function (endothelial microparticles) Long term · People diagnosed with periodontitis | MD -565.52 [-806.04, -325.00] | 1 study | Ungraded |
Adverse events (participants with adverse events or withdrawals due to adverse events) | SoF 2 (Adverse effects): 3 studies reported no adverse effects. 328 (3 studies); Moderate. | 3 studies · 328 participants | Moderate Downgraded: imprecision |
Endothelial function (flow-mediated dilation) Short term · People diagnosed with periodontitis and hypertension | MD 1.63 [0.43, 2.83] | 1 study | Ungraded |
Bleeding on probing (BOP) Long term · People diagnosed with periodontitis | MD -0.40 [-0.45, -0.35] | 1 study | Ungraded |
Plasma level of IL-6 (pg/mL) Short term · People diagnosed with periodontitis | MD -0.08 [-0.78, 0.61] | 2 studies | Ungraded |
Clinical attachment level (CAL) Short term · People diagnosed with periodontitis and hypertension | MD -0.49 [-0.67, -0.32] | 1 study | Ungraded |
Endothelial function (endothelial microparticles) Short term · People diagnosed with periodontitis | MD -384.42 [-625.58, -143.26] | 1 study · 107 participants | Ungraded |
Pocket probing depth (PPD) Short term · People diagnosed with periodontitis | MD -11.47 [-18.54, -4.40] | 1 study | Ungraded |
Change in systolic blood pressure (SBP, mmHg) Short term (follow-up 2-3 months) · People diagnosed with periodontitis | MD -3.55 [-10.09, 2.98] | 2 studies · 227 participants | Very low Downgraded: imprecision, inconsistency |
Clinical attachment level (CAL) Short term · People diagnosed with periodontitis | MD -10.50 [-17.17, -3.83] | 1 study | Ungraded |
Plasma level of IL-6 (pg/mL) Long term · People diagnosed with periodontitis | MD -0.20 [-1.33, 0.93] | 2 studies | Ungraded |
Pocket probing depth (PPD) Short term · People diagnosed with periodontitis and hypertension | MD -0.55 [-0.70, -0.40] | 1 study | Ungraded |
Change in systolic blood pressure (SBP, mmHg) Long term (follow-up 6 months) · People diagnosed with periodontitis | MD -6.64 [-16.83, 3.55] | 2 studies · 227 participants | Very low Downgraded: imprecision, inconsistency |
Bleeding on probing (BOP) Short term · People diagnosed with periodontitis | MD -0.42 [-0.47, -0.37] | 1 study | Ungraded |
Any periodontal treatment (subgingival scaling and root planing (SRP) must be included; may add supra-gingival scaling, systemic/local antibiotic or host modulation treatment, or periodontal surgery) vs No periodontal treatment
Population: Adults (any age/sex) with chronic periodontitis (>=5 teeth remaining; PPD >4 mm), with or without hypertension
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adverse events (participants with adverse events or withdrawals due to adverse events) | no estimate extracted | NR | No studies |
Proportion of participants diagnosed with hypertension at trial completion | no estimate extracted | NR | No studies |
Endothelial function | no estimate extracted | NR | No studies |
Bleeding on probing (BOP) | no estimate extracted | NR | No studies |
Plasma level of hs-CRP (mg/L) | no estimate extracted | NR | No studies |
Heart rate | no estimate extracted | NR | No studies |
Plasma level of IL-6 (pg/mL) | no estimate extracted | NR | No studies |
Change in diastolic blood pressure (DBP, mmHg) | no estimate extracted | NR | No studies |
Clinical attachment level (CAL) | no estimate extracted | NR | No studies |
Change in systolic blood pressure (SBP, mmHg) | no estimate extracted | NR | No studies |
Pocket probing depth (PPD) | no estimate extracted | NR | No studies |
Any periodontal treatment (subgingival scaling and root planing (SRP) must be included; may add supra-gingival scaling, systemic/local antibiotic or host modulation treatment, or periodontal surgery) vs Alternative periodontal treatment
Population: Adults (any age/sex) with chronic periodontitis (>=5 teeth remaining; PPD >4 mm), with or without hypertension
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Plasma level of hs-CRP (mg/L) | no estimate extracted | NR | No studies |
Clinical attachment level (CAL) | no estimate extracted | NR | No studies |
Bleeding on probing (BOP) | no estimate extracted | NR | No studies |
Adverse events (participants with adverse events or withdrawals due to adverse events) | no estimate extracted | NR | No studies |
Pocket probing depth (PPD) | no estimate extracted | NR | No studies |
Heart rate | no estimate extracted | NR | No studies |
Change in systolic blood pressure (SBP, mmHg) | no estimate extracted | NR | No studies |
Change in diastolic blood pressure (DBP, mmHg) | no estimate extracted | NR | No studies |
Proportion of participants diagnosed with hypertension at trial completion | no estimate extracted | NR | No studies |
Endothelial function | no estimate extracted | NR | No studies |
Plasma level of IL-6 (pg/mL) | no estimate extracted | NR | No studies |