The use of chlorhexidine mouthwash and diagnosis of primary hypertension in a large hospital cohort

Objectives: Small-scale studies reported increased blood pressure in patients using chlorhexidine mouthwash with the rationale that the rinse mitigates nitric oxide production by oral bacteria. The present study evaluated whether prior use of chlorhexidine mouthwash can be associated with an increased odds ratio (OR) for primary hypertension in a large hospital cohort. Method and materials: The i2b2 NIH-established platform was used to search for deidentified medical information coded by ICD-10 for subjects with a hypertension diagnosis who have used chlorhexidine rinses before between October 2015 and May 2024. Binary statistics and logistic regression were used to calculate the OR for hypertension in the group that used chlorhexidine mouth rinse before and after adjustments for demographic data, diabetes, and periodontal disease.
Results: The unadjusted OR for primary hypertension in subjects who used chlorhexidine gluconate mouthwash before was significantly elevated (OR 3.09, 95% CI 3.03 to 3.16, P .0001). It remained significant after adjusting for male sex (OR 3.07, 95% CI 3.00 to 3.13, P .0001), age 45 years (OR 4.00, 95% CI 3.92 to 4.09, P .0001), White race (OR 2.49, 95% CI 2.44 to 2.55, P .0001), diabetes (OR 2.68, 95% CI 2.61 to 2.74, P .001), and periodontal disease (OR 3.21, 95% CI 3.21 to 3.34, P .0001). The OR for hypertension for subjects with gingivitis or periodontal disease after adjustment for chlorhexidine mouthwash was elevated (OR 20.11, 95% CI 20.11 to 21.44, P .0001).
Conclusions: With the caveat of a retrospective study design, the results indicate an increased OR for primary hypertension for subjects with prior use of chlorhexidine mouthwash. (Quintessence Int 2025;56:138–142; doi: 10.3290/j.qi.b5872795) Keywords: blood pressure, chlorhexidine, mouthwash, primary hypertension