2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines | Circulation

The 10 Warning Signs Of High Blood Pressure – And What To Do About It

Access Denied You don't have permission to access "http://www.Telegraph.Co.Uk/health-fitness/conditions/heart-health/why-blood-pressure-high/" on this server.

Reference #18.6924c317.1734847693.899eb72c

https://errors.Edgesuite.Net/18.6924c317.1734847693.899eb72c

Wait, Can Mouthwash Cause High Blood Pressure?

Ever thought your daily mouthwash routine could be affecting more than just your breath? Turns out, regular use of mouthwash might have some unexpected side effects, like raising your blood pressure. It might sound out there, but research over the last decade has pointed to a possible connection between your mouthwash use and your blood pressure reading.

Before you freak out and toss the bottle under your sink, let's dive into what the science actually says about this surprising finding—including whether certain people are at a higher risk of high blood pressure from mouthwash and if certain types of minty freshness are safer.

What does the current research say?

A couple of studies have reported a link between mouthwash and high blood pressure. The most recent observational study, published in 2020 in Blood Pressure, found that people who used mouthwash twice a day or more1 had a higher risk of hypertension, even when other risk factors (like overweight and heart issues) were taken into account.

Another small 2015 study found that using antibacterial mouthwash for just three days raised the top number2 of blood pressure (aka systolic) in people around age 65 with hypertension but didn't affect the bottom number (aka diastolic).

Related Stories

{{ truncate(post.Title, 12) }}

So, what's the connection? "A healthy oral microbiome3 is linked to a healthy cardiovascular system," John Higgins, MD, a sports cardiologist at UTHealth Houston, tells Well+Good. But mouthwash can disrupt that balance of bacteria in your mouth, which can lead to possible complications like high blood pressure, he adds.

In addition to bad bacteria, mouthwash can also kill certain good bacteria that produce a natural chemical called nitric oxide, says Dr. Higgins. This chemical acts as a vasodilator, meaning it widens your blood vessels (so more blood can flow through them) and thereby lowers your blood pressure. But when you use mouthwash, you can, in theory, wipe out good-for-you bacteria and destroy this nitric oxide-generating pathway. As a result, this can potentially affect your blood pressure.

On the other hand, some studies have not found a connection at all. A 2019 study in Free Radical Biology and Medicine reported the use of antibacterial mouthwash did not spike blood pressure4 in vegetarians or omnivores (i.E., people who eat meat and plants). Another 2016 study had similar findings: Three days of rinsing with an antiseptic mouthwash three times daily did not affect blood pressure5 in young, healthy women.

Bottom line? Researchers have developed theories as to why blood pressure can be heightened from mouthwash use, and a few studies support these theories, but more research is needed to confirm their results.

Are certain people more at risk?

Dr. Higgins says certain people are more at risk of developing high blood pressure from mouthwash use. This includes people with a family history of heart problems or with current hypertension or diabetes. Age is also another risk factor, which Dr. Higgins pointed out as most studies that found a link between blood pressure and mouthwash involved older folks.

Aside from family history, preexisting diabetes, and age, other risk factors for hypertension include the following:

Your assigned sex at birth (Males are more likely to get high blood pressure until age 64, while females are more likely to get high blood pressure after age 65.)

Your race (Certain racial and ethnic groups, such as Black, Hispanic, and Asian adults, have higher rates of high blood pressure.)

Chronic kidney disease

Lack of physical activity

An unhealthy diet, especially one high in sodium

Having overweight or obesity

Drinking too much alcohol

Sleep apnea

High cholesterol

Smoking and tobacco use

Stress

Does this mean you should stop using mouthwash?

No, you don't have to pour your mouthwash down the drain just yet, Dr. Higgins says. We need more studies to confirm whether there's a real connection between mouthwash and high blood pressure, he adds.

In the meantime, if you have existing blood pressure problems (or risk factors for developing hypertension), you might want to play it safe. "For now, limit the use of antiseptic mouthwashes," Dr. Higgins says. Specifically, he recommends avoiding bactericidal mouthwashes (i.E., those that kill bacteria), which include active ingredients like:

Will your blood pressure return to normal if you stop using mouthwash?

If your blood pressure spikes are stemming from mouthwash use, it's possible that your levels may return to a healthy range once you stop using mouthwash. According to Dr. Higgins, the uptick in your blood pressure seems to be rather short-lived, only lasting a few days to a week after exposure.

And keep in mind: there are several other possible reasons why your blood pressure reading may be high. To fully determine the underlying cause, it's best to visit your healthcare provider so they can take your vitals and run some tests.

That said, if you're still considering ditching mouthwash and looking to protect the delicate balance of your oral microbiome, Dr. Higgins suggests reintroducing probiotic bacteria "by taking oral probiotic supplements." Just be sure to talk to your healthcare provider before trying any new vitamins or supplements.

Are certain types of mouthwash safer?

A clean mouth isn't just about having fresh, minty breath. Good oral hygiene is important for heart health, too. So, if mouthwash is part of your routine, you don't have to skip the swish-and-swirl altogether. "Instead, try natural mouthwashes that are not bactericidal," Dr. Higgins says. Unlike antiseptic mouthwashes, natural rinses don't eradicate oral bacterial flora or mess with your nitric oxide production. In other words, they shouldn't affect your blood pressure.

Okay, so what ingredients should you look for? Mouth rinses including coconut oil, fluoride, salt, and lemon peel oil appear to be safe, Dr. Higgins says. If you're still unsure which mouthwash is a good fit for you, talk with your healthcare provider or dentist. They can point you in the right direction.

Well+Good articles reference scientific, reliable, recent, robust studies to back up the information we share. You can trust us along your wellness journey.

Joshipura, Kaumudi et al. "Over-the-counter mouthwash use, nitric oxide and hypertension risk." Blood pressure vol. 29,2 (2020): 103-112. Doi:10.1080/08037051.2019.1680270

Bondonno, Catherine P et al. "Antibacterial mouthwash blunts oral nitrate reduction and increases blood pressure in treated hypertensive men and women." American journal of hypertension vol. 28,5 (2015): 572-5. Doi:10.1093/ajh/hpu192

Deo, Priya Nimish, and Revati Deshmukh. "Oral microbiome: Unveiling the fundamentals." Journal of oral and maxillofacial pathology : JOMFP vol. 23,1 (2019): 122-128. Doi:10.4103/jomfp.JOMFP_304_18

Ashworth, Ann et al. "Dietary intake of inorganic nitrate in vegetarians and omnivores and its impact on blood pressure, resting metabolic rate and the oral microbiome." Free radical biology & medicine vol. 138 (2019): 63-72. Doi:10.1016/j.Freeradbiomed.2019.05.010

Sundqvist, Michaela L et al. "Effects of antiseptic mouthwash on resting metabolic rate: A randomized, double-blind, crossover study." Nitric oxide : biology and chemistry vol. 61 (2016): 38-44. Doi:10.1016/j.Niox.2016.10.003

The Wellness Intel You Need—Without the BS You Don't

Sign up today to have the latest (and greatest) well-being news and expert-approved tips delivered straight to your inbox.

Dear Doctor: What Is High-output Heart Failure, And How Is It Treated?

DEAR DR. ROACH: My husband is 73 and was diagnosed with heart failure and a severely dilated left ventricle. At the time, he was pumping 10 liters per minute. He had a proBNP natriuretic peptide level over 10,000 and an ejection fraction of 39%. Later, he was found to have an abdominal arteriovenous malformation (AVM). He underwent three radiological procedures to reduce the size of the AVM.

One year post-procedure, his cardiac output was 5.7 liters per minute; his proBNP level was 1,300; and his ejection fraction was 54%. Clearly, the AVM was the source of the high-output congestive heart failure, and the three embolization procedures were effective. All his symptoms disappeared after the procedures, and he feels stronger and more vital than he has in years. He hikes several miles daily, bikes occasionally, and is able to climb a sand dune without getting winded.

My question is: Does he still have a high-output diagnosis if his heart is pumping at 5.7 liters per minute? If so, what is the proper treatment for someone with this condition? He is currently being treated with minimal doses of lisinopril and Coreg. He would like to know if the dilation to his left ventricle is permanent or will diminish over time. -- K.B.

ANSWER: Heart failure is simply when the heart is unable to pump all the blood it needs to meet the body's demands. Heart failure is broken down into big two categories based on the ejection fraction (EF) of the heart, which is the percentage of blood that the left ventricle squeezes out during each beat.

The EF is normally 50% to 75%, so heart failure with an EF of less than 50% is heart failure with reduced ejection fraction (HFrEF). Meanwhile, if a person has heart failure symptoms and an ejection fraction of 50% or greater, it's heart failure with preserved ejection fraction (HFpEF).

Most cases of heart failure are due to heart disease from longstanding high blood pressure levels, repeated heart attacks, or a condition called idiopathic dilated cardiomyopathy. Your husband has a less-common cause called high-output heart failure. In his case, he has an AVM. This is a direct connection of the arteries and veins that usually occurs in the colon but can be found in other places within the gastrointestinal tract.

You can think of it as a short-circuit of the blood supply; all the oxygenated blood going through the AVM does no good at all, and the heart has to work extra hard to provide the blood that the rest of the body needs. Closing the AVM by blocking it up stops the short-circuit so the heart doesn't have to work as hard.

The best news for your husband is that his symptoms are better. But it's also great that his ejection fraction is now in the normal range and that his BNP is better. Of course, 1,300 is still very abnormal, but it's much better than 10,000.

It takes time for the heart to recover from high-output heart failure. I don't know if there still is some blood going through his AVM, but based on his symptoms, I am optimistic that most, if not all, of the underlying cause is gone. Lisinopril and carvidolol (Coreg) are very standard treatments for heart failure and help to protect the heart.

* * *

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.Cornell.Edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

(c) 2022 North America Syndicate Inc.

All Rights Reserved

If you purchase a product or register for an account through a link on our site, we may receive compensation. By using this site, you consent to our User Agreement and agree that your clicks, interactions, and personal information may be collected, recorded, and/or stored by us and social media and other third-party partners in accordance with our Privacy Policy.

---