Association Between Pulsatile Components of Blood Pressure and Severe Tooth Loss in Rural Ecuador: The Three Villages Study

Abstract

Background: Arterial hypertension has been associated with severe tooth loss, but differential associations with individual components of blood pressure (BP) have scarcely been investigated. We assessed the independent associations between pulsatile/steady components of BP and severe tooth loss in community-dwelling adults residing in 3 rural Ecuadorian villages. Methods: Individuals aged ≥40 years living in Atahualpa, El Tambo, and Prosperidad were identified during door-to-door surveys. Data collection focused on the number of remaining teeth and measurements of pulsatile/steady components of BP. Multivariate models were fitted to assess independent associations between pulsatile/steady BP components and severe tooth loss, after adjusting for relevant covariates. Results: A total of 1543 individuals were included. Oral exams identified 426 (28%) individuals with severe tooth loss. BP levels ≥140/90 mm Hg were determined in 481 (31%) individuals. The mean pulse pressure (PP) level was 55.3 ± 19 mm Hg. For systolic BP (SBP), the mean level was 133.1 ± 23.5 mm Hg, and for diastolic BP (DBP) it was 77.8 ± 11.5 mm Hg. Univariate models showed significant associations between severe tooth loss and SBP and PP, but not with DBP. However, the significance was taken away in fully adjusted generalized linear models. Age remained as an independent significant covariate in models using SBP and PP. Causal mediation analyses disclosed that percentages of the effect of severe tooth loss mediated by age were 99.5% for SBP and 98.9% for PP. Conclusion: This study shows that age captures most of the effect of the association between pulsatile components of BP and severe tooth loss.

Keywords: aging; arterial hypertension; population study; pulsatile blood pressure; pulse pressure; tooth loss.

Figure 1.

Contours plots with Shepard interpolation showing the effect of age in the association between severe tooth loss and the different components of blood pressure. Upper panel corresponds to systolic blood pressure (SBP), central panel to pulse pressure (PP) and lower panel to diastolic blood pressure (DBP). Upper and central panel plots show large clusters of individuals with severe tooth loss (in red) among older adults irrespective of SBP and PP levels. In addition, a cluster of individuals with severe tooth loss is noted among younger adults at higher levels of SBP and PP. In contrast, the lower panel suggests an unpredictable effect of age in the association between severe tooth loss and DBP by showing clusters of individuals with severe tooth loss at different levels of DBP and age.