The Potential Effects of ACE Inhibitors on the Severity of Periodontal Disease-Related Attachment Loss: An Observational, Cross-Sectional Comparative Study

Background/Objectives: Angiotensin-converting enzyme (ACE) inhibitors are commonly prescribed anti-hypertensive agents. However, one of their effects is reducing the breakdown of a number of pro-inflammatory mediators, including bradykinin and substance P. Given the role of inflammation in periodontal disease, the aim of this study was to see whether ACE inhibitors may have an influence on the severity of periodontal disease, as assessed by clinical attachment loss. Methods: A case–control retrospective study was undertaken through analysis of patient records from a specialist periodontic practice. Data regarding the loss of clinical attachment was collected from patients who were non-smokers and grouped according to patients prescribed ACE inhibitors, those taking other antihypertensive medication, and those taking no antihypertensive medication. Results: No statistically significant difference was observed between the three treatment groups in terms of mild to moderate loss of attachment (1–3 mm; 4–5 mm). However, a significantly higher incidence of severe attachment loss (>6 mm) was observed in patients prescribed ACE inhibitors, as compared to another antihypertensive or no antihypertensive medication. Conclusions: The incidence of severe loss of clinical attachment in this study was highest in those patients being prescribed ACE inhibitors. This effect would appear to be independent of the effects of the medication on blood pressure, since this was not observed with other antihypertensive medications, and hence may potentially relate to the known pro-inflammatory action of ACE inhibitors.