Association Between Arterial Hypertension and Periodontitis: A Systematic Review and Meta-Analysis

Background: Periodontitis and arterial hypertension are highly prevalent chronic conditions that share common risk factors and inflammatory pathways. Increasing evidence suggests a potential association between both diseases; however, the strength and consistency of this relationship remain unclear. Methods: A systematic review and meta-analysis of observational studies was conducted following PRISMA guidelines. Electronic searches were performed in PubMed (MEDLINE), Scopus, and the Cochrane Library without date restrictions. Studies evaluating the association between periodontitis and arterial hypertension in humans were included. Risk of bias was assessed using the Newcastle-Ottawa Scale. A random-effects meta-analysis was performed using adjusted odds ratios (ORs). Results: Thirty-six studies were included in the systematic review; of these, 11 studies reporting a directly comparable, adjusted odds ratio were included in the quantitative meta-analysis, comprising a total of 48,761 participants. The pooled analysis demonstrated a statistically significant association between periodontitis and hypertension (OR = 1.65; 95% CI: 1.42-1.93; p < 0.00001). Heterogeneity was substantial (I² = 65%) but was partly explained by periodontal case definition, with a stronger association among studies using the AAP/EFP classification (OR = 1.90; 95% CI: 1.57-2.30) than those using alternative periodontal indices (OR = 1.35; 95% CI: 1.21-1.50). The overall certainty of evidence, assessed using GRADE, was rated as Very Low. Conclusions: This systematic review and meta-analysis identifies a consistent positive association between periodontitis and arterial hypertension across observational studies. Given the very low certainty of the underlying evidence, this finding should be interpreted as a signal warranting further investigation rather than a robust, settled conclusion. Causality cannot be established from the available observational evidence, and the potential relevance of periodontal health to cardiovascular risk merits further research.