Table 1: Basic characteristics of participants. Women (n = 81) 52.09 ± 3.92 139.93 ± 26.60 80.33 ± 20.80 28.57 ± 6.69 5.33 ± 1.23 1.63 ± 0.93 1.34 ± 0.39 5.22 ± 1.43 4.20 ± 2.32 3.74 ± 1.47 2.37 ± 0.66 3.70 ± 3.81 2 Parameter Age (year) SBP (mmHg) DBP (mmHg) BMI Total-C TG HDL- C HbA1c Vegetables (days/week) Fruit (days/week) Periodontitis Tooth loss Values are presented as mean ± standard deviation (SD). BMI: Body Mass Index (body weight/height2, kg/m2), Total-C: serum total cholesterol (mmol/L), TG: triglycerides (mmol/L), HDL-C: high-density-lipoprotein cholesterol (mmol/L), and HbA1c: glycosylated hemoglobin (%). Vegetable and fruit intakes are expressed as the number of days per week when they were consumed. Periodontitis: the average CPTIN of each tooth. Tooth loss: number of teeth lost. alcoholic drinks, and investigated the possible association of periodontitis and tooth loss with the risk factors for HT in the present study. 2. Methods 2.1. Study Design and Subjects. The present study was conducted in Tanzania according to the protocol for Car- diovascular Diseases and Alimentary Comparison (CAR- DIAC) Study coordinated by the World Health Organiza- tion (WHO) [12–14]. We previously reported associations between HT and its traditional risk factors such as body mass index (BMI), salt intake, and Na/K ratio in the CARDIAC study in Tanzania [14–18]. One hundred women aged 46– 58, living in Temeke, Dar es Salaam, were randomly selected from an administrative list and invited to participate in the study by letter. Detailed oral examination was limited to women because of the higher prevalence of smokers and alcohol drinkers among men, who were therefore considered not suitable for analysis of the association of oral health with dietary factors [7]. Eighty-one women responded to the invitation for BP and anthropometrical measurements, 24- hour urine collection, blood sampling, dental examination, and lifestyle questionnaires. This study was approved by the Institutional Ethical Review Board of Muhimbili University College of Health Science. Written informed consent was obtained in accordance with the institutional rules. 2.2. Health Examination. In order to eliminate observer bias, BP was measured using a centrally calibrated automatic BP measurement system used for the CARDIAC Study (Khi machine) [12, 13]. BP was measured 3 times for each subject, and the average of the 3 measurements was used in this analysis. Blood was sampled after a 10–14 h fast. Urinary bags (U-container N, Ono Medical Company Osaka, Japan) International Journal of Hypertension were used for collecting 24-hour urine and the validity was conﬁrmed by checking creatinine excretion [13]. Blood and urine samples for the CARDIAC Study were analyzed cen- trally at the former WHO Collaborating Center for Research on Primary Prevention of Cardiovascular Diseases, Graduate School of Human and Environmental Studies, Kyoto Uni- versity, Kyoto, Japan. Details of other health examination methods were described in previous reports on the protocol and ﬁndings of the CARDIAC study in Tanzania [14]. 2.3. Oral Examination. A single examiner (M.Y.) carried out, without knowing other health-related data, the oral exam- ination including tooth count and the assessment of peri- odontitis, which was measured according to the WHO com- munity periodontal index of treatment needs (CPITN). The specially designed WHO periodontal probe with a sensing force of not over 20 g was utilized. The ten teeth examined were 17, 16, 11, 26, 27, 47, 46, 31, 36, and 37; for each tooth, the highest index found was recorded according to the following scale: (0) periodontal health; (1) gingival bleeding; (2) calculus detected during probing; (3) pocket 4 to 5 mm deep; and (4) pocket 6 mm deep and over. Periodontal con- dition was reported as the average CPTIN condition of each tooth, the scoring for which is well established and regarded as the global standard measurement for epidemiological and screening studies on periodontitis [19–21]. 2.4. Statistical Analysis. Data were analyzed using the pro- gram Statview 5 for microcomputers from the SAS Institute Inc. Simple correlation analysis using the Pearson method allowed the assessment of univariate relationships. The variables were regarded as normally distributed. 3. Results In this study, we assessed the association of tooth loss and periodontitis with BP, and the traditional risk factors of HT in 81 women aged 46–58 years, whose basic characteristics are shown in Table 1. None of the subjects in this population was found to be using or have used drugs that aﬀect lipid metabolism, BP, or blood sugar. Additionally, they had never smoked and never drunk alcohol because of their local Islamic religious discipline and culture. In multiple-regression analysis, the severity of periodon- titis was signiﬁcantly correlated with systolic BP (SBP) (r = 0.288, P = 0.018) and diastolic BP (DBP) (r = 0.293, P = 0.015), and tooth loss (the number of teeth missing) was also signiﬁcantly correlated with SBP (r = 0.308, P = 0.010) and DBP (r = 0.417, P = 0.0005) (Table 2). These results indicate that periodontitis and tooth loss are signiﬁcantly and inde- pendently associated with increases in BP in nonsmoking middle-aged Tanzanian women. In addition, to assess the association between HT and periodontitis, participants were divided into 3 groups. The severely hypertensive (SBP > 180 or DBP > 110) group had a signiﬁcant diﬀerence in the sever- ity of periodontitis (CPITN, 2.82 ± 0.64; mean ± standard deviation (SD)) from the normal to borderline hypertensive BP (SBP < 160 or DBP < 100) group (2.29 ± 0.61, P < 0.05).