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Saliva, Blood pressure, Viscosity, Buffer, IntroductionHigh blood pressure (BP) or hypertension is one of the many challenges among elderly people most of them need to take antihypertensive medications. Stabled systolic BP &,ge 140 mmHg and/ or a stabled diastolic BP &,ge 90 mmHg are defined as hypertension in adults. High BP can gradually lead to higher morbidity and mortality rates because of cardio vascular diseases [ 1,]. Saliva is the most important oral fluid and saliva pH and viscosity are among the most important properties of saliva, which have not been studied fully.Systemic diseases and every day medications used by the patient can cause change the quantity and quality of secreted saliva by salivary glands, effecting the patient&,rsquo s quality of life [ 2,, 5,].The viscosity of secreted saliva is dependent on many factors such as its protein content or inorganic part. Any disturbances in saliva viscosity can indicate the changes in saliva content and may have an impact on the health and integrity of oral mucosa. In addition, saliva pH is one of the most important features of saliva and is directly correlated to the buffering capacity of secreted saliva, and plays a significance role in mai-ntaining oral dental health and dental integrity [ 6,, 7,].The prevalence of hypertension is increased by age [ 1,] and many studies have been conducted on this problem but there is little information about the influence of hypertension and its treatments on saliva properties and theinfluence on salivary gland function. Since high BP has many effects on body fluids including saliva, these effects need to be determined [ 2,, 8,]. Thus, the aim of this study was to evaluate the relationship between hypertension and pH and viscosity of cumulative saliva in adults with hypertension.Materials and MethodThis cross sectional study was conducted on patients referred to Oral Medicine Faculty of Shahid Sadoughi University of Medical Sciences. The Ethical Committee of Shahid Sadoughi University of Medical Sciences of Yazd (No ir.ssu.rec.1395.128) approved this study. The medical history of participants were obtained by interview and recorded in their files. Using sequential sampling, 135 patients were included in this study after receiving a written consent form from all participants. According to their BP, they were divided in to 3 groups with 45 participates in each. All groups were matched for age and gender.The inclusion criteria for participants were just hypertensive individuals with no other systemic disease, taking no other medications (except antihypertensive medications such as losartan, beta-blockers, and so on) and no history of smoking or alcohol use. Patients who were taking diuretics for their hypertension or taking medications, which are known to induce xerostomia such as antidepressants, were excluded from the study. BP was taken twice (by 5 minutes intervals) after each individual was seated comfortably on the chair for at least 5 minutes, by SANA automatic Sphygmomanometer (model HL868RT, made by Health and life Company in Taiwan). To reduce inter- examiner error, automatic Sphygmomanometer was used.Hypertension was defined as systolic BP more than 140 mmHg and diastolic BP more than 90 mmHg. The participants were divided into 3 even groups. Group 1 consisted of 45 normotensive individuals (BP less than 120/80 mmHg, not taking medications), group 2 consisted of 45 borderline hypertensive individuals (systolic BP in range of 120-139 or diastolic BP in range of 80-89 mmHg, not taking medications), and group 3 consisted of 45 stage I hypertensive individuals (systolic BP in range of 140-159 or diastolic BP in range of 90-99 mmHg). Spitting method was used to collect the unstimulated whole saliva. All of the saliva samples were collected at 25 degrees C. at 9-11 A.M. Individuals were forbidden to eat, drink, smoke, or brush their teeth, at least 90 minutes before sampling in order to decrease the influence of daily changes on the composition of saliva.Before sampling, participants were remained seated on the chair and asked to swallow all the saliva in their mouth. Then, they were asked not to swallow their saliva for 5 minutes and spit the collected saliva into the sterilized cups provided by the investigators.Immediately after sampling, pH of the saliva samples were measured by Pen-type digital pH-meter set (AZ Company, Taiwan). In addition, the viscosity of samples was immediately measured by comparing the amount of displacement of saliva in the calibrated thistle tube to that of control fluids. Control fluids were glycerin (Viscosity=830 mm^2/s (cSt)) and water (Viscosity=1 mm^2/s (cSt)) and the amount of displacement of the fluid in the thistle tube was compared to the control fluids within 10 seconds (mm/10 s) in this study. According to Shapiro test, data distribution was normal and ANOVA test was used to compare the groups. When the differences were significant, Tukey multiple comparisons and/or nonparametric equivalent was used to compare groups pair wise. The p&,lt 0.05 was regarded significant.ResultsIn this study, 51% of individuals were male and 49%were females. In addition, 16% of individuals were taking antihypertensive medications including 82% took Losartan and 18% propranolol. Furthermore, 76% of individuals took only one medication and 24% took two. All groups were matched regarding gender and age. The mean ages of the 3 groups were 45.59 years for group 1 (SD,12.08), 45.53 years for group 2 (SD,9.91) and 46.56 years (SD,13.40) for group 3. The mean and standard deviation of salivary pH of three groups are compared in Table 1,. As shown in Table 1, and Table 2,, the average pH was higher in the group 1 than that in group 2 (p=.0001) and it was higher in group 2 than in group 3 (p=.005). These differences were statistically significant. As shown in Tables 3, and 4,, the average of displacement of saliva in the thistle tube at mm/10s in group1 was more than group 2 (p=.005) and greater in the group 2 than that in group 3 (p=.0001). These differences were statistically significant (p&,lt .05).Discussion The results of this study demonstrated the relationship between hypertension, antihypertensive medications, and their influence on saliva properties. The participants involved in this study were only hypertensive individuals without any other systemic diseases and a few of them took particular medications for their high BP (such as losartan, beta-blockers) but not diuretics because it has been shown that diuretics cause xerostomia [ 1,, 2,].GroupsStd.DeviationMeanNumberGroup 1 (Normal BP)0.426286.48745Group 2 (Pre-hypertension)0.505266.06045 Group 3 (Stage I hypertension)0.569595.85145ANOVA Test p= 0.000 |