Abstract
BACKGROUND: Oral microbiome diversity has been associated with general health. However, its association with long-term outcomes in hypertensive individuals remains unclear. OBJECTIVES: This study aimed to investigate whether oral microbiome diversity is associated with all-cause mortality in hypertensive individuals. DESIGN: Data from 2,669 hypertensive individuals in the National Health and Nutrition Examination Survey (NHANES, 2009-2012) were analyzed. Oral microbiome diversity was assessed using four alpha-diversity metrics: the Simpson index, Shannon-Weiner index, Faith's Phylogenetic Diversity, and observed amplicon sequence variants (ASVs). Weighted multivariable Cox proportional hazards regression and interaction analyses were conducted. RESULTS: During a mean follow-up of 8.61 years, 268 all-cause deaths occurred. Higher oral microbiome diversity assessed by the Simpson index (hazard ratio [HR] = 0.38; 95% confidence interval [CI], 0.20-0.75; P (trend) < 0.01) and Shannon-Weiner index (HR = 0.47; 95% CI, 0.25-0.88; P (trend) < 0.05), was significantly associated with reduction in all-cause mortality risk. A potential interaction between sex and oral microbiome diversity on mortality risk was observed. CONCLUSIONS: Higher oral microbiome diversity is an independent protective factor for survival in patients with hypertension, with potential sex-specific differences in this association. These findings suggest that enhancing oral microbiome diversity may potentially help promote overall health in individuals with hypertension.