A Connection Between Sublingual Varices and Hypertension?
A total number of 454 patients were invited to participate in the study. Seventeen patients (3.7 %) resigned from the study (fifteen patients did not want to enter the study, two patients were excluded due to atrial fibrillation). Of the remaining 437 patients, 2 were excluded due to lack of photographs of the tongue, and 4 patients refused to visit the district nurse for follow-up after initial high blood pressure was observed at inclusion. In total 431 patients underwent the complete study protocol. The total dropout number was thus 23 patients (5.1 %; Fig. 3).
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Figure 3.
Flowchart of the study population
The 431 patients who underwent the complete study protocol had a mean age of 55.3 years (SD 10.9). The gender distribution was 188 male and 243 female. The prevalence of smokers was 46 (10.7 %), and 202 (46.9 %) expressed heredity for hypertension. For 92 patients, previously known hypertension was reported (21.3 %) with a mean duration from diagnosis of 7.2 years (SD 7.2), and another 28 patients (6.5 %) had other cardiovascular disease (angina pectoris, myocardial infarction or stroke) and 30 patients (7.0 %) had lower limb varices. During the study another 28 participants were identified having hypertension (Fig. 3). A total of 120 (27.8 %) individuals were thereby hypertensive in the current study.
The prevalence of sublingual varices was 26.5 % (114/431) in the study population, with 18.3 % among those having normal blood pressure, and 47.5 % among those diagnosed with hypertension (p < 0.0001).
The mean systolic blood pressure measured at inclusion at the dental clinic was 123.2 mm Hg (SD 17.3) in the group with grade 0 sublingual varices and 132.1 mm Hg (SD 19.3) in the group with grade 1 sublingual varices (Fig. 4; p < 0.0001). The mean diastolic blood pressure was 79.6 mm Hg (SD 12.2) in the group with few or no sublingual varices (grade 0) and 83.4 mm Hg (SD 13.3) in the grade 1 sublingual varices group (Fig. 5; p = 0.005).
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Figure 4.
Mean systolic blood pressure with 95 % confidence intervals in patients with grade 0 (n=317) and grade 1 (n= 114) sublingual varices, respectively
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Figure 5.
Mean diastolic blood pressure with 95 % confidence intervals in patients with grade 0 (n = 317) and grade 1 (n = 114) sublingual varices, respectively
The prevalence of grade 1 sublingual varices increased with increasing blood pressure measured at inclusion at the dental clinic, from 21.8 % among those with normal blood pressure to 30.8 % among those with stage 1 hypertension (p = 0.02), and further to 43.6 % among those with stage 2 hypertension (p = 0.001).
In the group with newly diagnosed hypertension at the primary health care centre (n = 28), the prevalence of grade 1 sublingual varices was 46.2 % and 53.3 % in patients with stage 1 hypertension and stage 2 hypertension, respectively.
Age, smoking and hypertension were associated with sublingual varices ( Table 1 ). The prevalence of sublingual varices among non-smokers with hypertension was 44.7 % (46/103), and among smokers with hypertension 64.7 % (11/17).
The identification of sublingual varices as an indicator of hypertension would result in a sensitivity of 0.48, a specificity of 0.82, a positive predictive value (PPV) of 0.5, and a negative predictive value (NPV) of 0.80 ( Table 2 ). Sublingual varices as an indicator of hypertension in the subgroup of smokers showed a sensitivity of 0.65, a specificity of 0.2, a PPV of 0.58, and an NPV of 0.25.
The inter-observer agreement regarding photographs of the tongue, expressed as index of validity, was 0.87 and the Cohen's kappa coefficient was 0.68.
Results
A total number of 454 patients were invited to participate in the study. Seventeen patients (3.7 %) resigned from the study (fifteen patients did not want to enter the study, two patients were excluded due to atrial fibrillation). Of the remaining 437 patients, 2 were excluded due to lack of photographs of the tongue, and 4 patients refused to visit the district nurse for follow-up after initial high blood pressure was observed at inclusion. In total 431 patients underwent the complete study protocol. The total dropout number was thus 23 patients (5.1 %; Fig. 3).
(Enlarge Image)
Figure 3.
Flowchart of the study population
The 431 patients who underwent the complete study protocol had a mean age of 55.3 years (SD 10.9). The gender distribution was 188 male and 243 female. The prevalence of smokers was 46 (10.7 %), and 202 (46.9 %) expressed heredity for hypertension. For 92 patients, previously known hypertension was reported (21.3 %) with a mean duration from diagnosis of 7.2 years (SD 7.2), and another 28 patients (6.5 %) had other cardiovascular disease (angina pectoris, myocardial infarction or stroke) and 30 patients (7.0 %) had lower limb varices. During the study another 28 participants were identified having hypertension (Fig. 3). A total of 120 (27.8 %) individuals were thereby hypertensive in the current study.
The prevalence of sublingual varices was 26.5 % (114/431) in the study population, with 18.3 % among those having normal blood pressure, and 47.5 % among those diagnosed with hypertension (p < 0.0001).
The mean systolic blood pressure measured at inclusion at the dental clinic was 123.2 mm Hg (SD 17.3) in the group with grade 0 sublingual varices and 132.1 mm Hg (SD 19.3) in the group with grade 1 sublingual varices (Fig. 4; p < 0.0001). The mean diastolic blood pressure was 79.6 mm Hg (SD 12.2) in the group with few or no sublingual varices (grade 0) and 83.4 mm Hg (SD 13.3) in the grade 1 sublingual varices group (Fig. 5; p = 0.005).
(Enlarge Image)
Figure 4.
Mean systolic blood pressure with 95 % confidence intervals in patients with grade 0 (n=317) and grade 1 (n= 114) sublingual varices, respectively
(Enlarge Image)
Figure 5.
Mean diastolic blood pressure with 95 % confidence intervals in patients with grade 0 (n = 317) and grade 1 (n = 114) sublingual varices, respectively
The prevalence of grade 1 sublingual varices increased with increasing blood pressure measured at inclusion at the dental clinic, from 21.8 % among those with normal blood pressure to 30.8 % among those with stage 1 hypertension (p = 0.02), and further to 43.6 % among those with stage 2 hypertension (p = 0.001).
In the group with newly diagnosed hypertension at the primary health care centre (n = 28), the prevalence of grade 1 sublingual varices was 46.2 % and 53.3 % in patients with stage 1 hypertension and stage 2 hypertension, respectively.
Age, smoking and hypertension were associated with sublingual varices ( Table 1 ). The prevalence of sublingual varices among non-smokers with hypertension was 44.7 % (46/103), and among smokers with hypertension 64.7 % (11/17).
The identification of sublingual varices as an indicator of hypertension would result in a sensitivity of 0.48, a specificity of 0.82, a positive predictive value (PPV) of 0.5, and a negative predictive value (NPV) of 0.80 ( Table 2 ). Sublingual varices as an indicator of hypertension in the subgroup of smokers showed a sensitivity of 0.65, a specificity of 0.2, a PPV of 0.58, and an NPV of 0.25.
The inter-observer agreement regarding photographs of the tongue, expressed as index of validity, was 0.87 and the Cohen's kappa coefficient was 0.68.
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