The Association of Periodontitis and Stroke History: Exploring the Role of Hypertension in a Cross‐Sectional NHANES Analysis

Background: Periodontitis, a chronic inflammatory disease, and stroke, a leading cause of death and disability, share common risk factors and inflammatory pathways. However, the role of key mediators such as hypertension in this relationship remains to be fully elucidated. Methods: = 2,783). Periodontitis was classified according to standard NHANES protocols. Stroke history was self-reported. Survey-weighted multivariable logistic regression was used to assess the periodontitis-stroke association. Mediation analysis was performed to quantify the indirect association mediated through hypertension. Results: In unadjusted models, periodontitis was significantly associated with stroke (OR: 5.69; 95% CI: 2.24-20.61). After full adjustment, this association was no longer statistically significant (OR: 1.48; 95% CI: 0.53-5.67). Mediation analysis revealed a significant indirect association of periodontitis on stroke through hypertension (indirect association coefficient = 0.3685, 95% CI: 0.085-0.868), accounting for 31.30% of the total association. The direct association was not significant. Conclusions: Hypertension was identified as a significant mediator in the relationship between periodontitis and stroke. The impact of periodontitis on stroke may operate primarily through its association with blood pressure, highlighting the importance of integrated management of periodontal and cardiovascular health.