*4.4. Clinical Implications*

Given the significance of oral health in the nutritional status and general health of older adults, preserving remaining teeth and improving masticatory performance is critical. This study provided evidence that decreased posterior occlusal contact increases the risk of hypertension by 1.7 times. Hence, oral rehabilitation with dentures to maintain posterior occlusal contact may be recommended for improved masticatory performance, improved dietary intake, and a lower risk of hypertension. The findings of this study will also raise awareness about lifestyle changes that can reduce the risk of hypertension, such as lower salt intake, higher fruit and vegetable intake, maintaining a healthy weight, increasing exercise habits, decreasing smoking habits, and reducing alcohol consumption.

#### **5. Conclusions**

This study suggests that the risk of hypertension increased with age, higher BMI, higher sodium-to-potassium ratio, and lesser posterior occlusal contact. Therefore, maintaining posterior occlusal contact is vital in lowering the risk of hypertension. The findings of this study will aid in the improvement of oral health, nutritional intake, and general health by reducing the development of hypertension and potentially extending the healthy life expectancy of older adults.

**Author Contributions:** Conceptualization, P.M., Y.H., T.O. and K.S.; methodology, Y.H., T.O. and K.S.; software, Y.H. and K.T.; validation, Y.H.; formal analysis, P.M., Y.H., M.T.S.M. and T.Y.; investigation, Y.H., K.T., H.K. (Hiroshi Kusunoki), S.T., Y.W., T.S. and H.K. (Hiromitsu Kishimoto); resources, Y.H., K.T, H.K. (Hiroshi Kusunoki), S.T., Y.W., T.S., H.K. (Hiromitsu Kishimoto) and K.S.; data curation, Y.H. and K.T.; writing—original draft preparation, P.M. and Y.H.; writing—review and editing, Y.H., T.O. and K.S.; visualization, P.M., Y.H., T.O. and K.S.; supervision, Y.H., T.O. and K.S.; project administration, Y.H. and K.S.; funding acquisition, Y.H. and K.S. All authors have read and agreed to the published version of the manuscript.

**Funding:** This study was supported by the Hyogo Dental Association, 8020 Foundation, Mitsui Sumitomo Insurance Welfare Foundation, and by the Japan Society for the Promotion of Science (JSPS) Grant-in-Aid for Scientific Research (KAKENHI) (grant no. 16KT0012 of 2016–2018 to Ken Shinmura).

**Institutional Review Board Statement:** The study was conducted in accordance with the Declaration of Helsinki and approved by the ethics committee of Hyogo College of Medicine (approval no. Rinhi 0342). All methods were carried out in accordance with relevant guidelines and regulations.

**Informed Consent Statement:** Written informed consent has been obtained from all subjects involved in the study to publish this paper.

**Data Availability Statement:** The materials described in the manuscript, including all relevant raw data, will be freely available to any scientist wishing to use them for non-commercial purposes, by contacting the corresponding author without breaching patient confidentiality.

**Acknowledgments:** We would like to express our sincere appreciation to Masako Shiramizu at Otemae University, Colleagues in Hyogo College of Medicine Dental and Oral surgery, and all members of the FESTA (Frail Elderly in Sasayama-Tamba Area) research team (titles omitted) for their assistance in the implementation of this study (Hiroo Yoshikawa, Soji Shimomura, Koutatsu Nagai, Kyoko Sano, Masako Ito, Hatsuo Maeda, and Gaku Amano; and to everyone at the Hyogo College of Medicine Sasayama Medical Center).

**Conflicts of Interest:** The authors declare no conflict of interest.
