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Original Research

Open Access

Influence of antibacterial mouthwash on post-exercise hypotension

  • Yerim Choi1
  • Min-gyeong Kang2
  • Seung Kyum Kim1,2,*,

1Convergence Institute of Biomedical Engineering and Biomaterials, Seoul National University of Science and Technology, 01811 Seoul, Republic of Korea

2Department of Sports Science, Seoul National University of Science and Technology, 01811 Seoul, Republic of Korea

DOI: 10.31083/j.jomh1805117 Vol.18,Issue 5,May 2022 pp.1-7

Submitted: 19 October 2021 Accepted: 21 December 2021

Published: 31 May 2022

*Corresponding Author(s): Seung Kyum Kim E-mail:


Background: Acute exercise induces a blood pressure (BP) reduction that lasts minutes to hours, which is called post-exercise hypotension (PEH). Accumulating data suggest that oral bacteria play a role in BP regulation by contributing to nitric oxide production, implying that antibacterial mouthwash (AM) could affect PEH. Therefore, this study aimed to investigate the effects of an AM on post-exercise changes in BP and arterial stiffness index (ASI). Methods: Ten healthy young men completed two treadmill exercises at moderate intensity. After exercise, the subjects rinsed their mouth for 1 min with AM or nitrite-free water at 5, 35, 65, and 95 min during the recovery period. BP and ASI were assessed at 0, 10, 20, 30, 60, 90, and 120 min during the recovery period. Heart rate (HR) and blood lactate (BL) were also measured. Results: As expected, PEH occurred showing a decrease in the systolic, diastolic, and mean arterial pressures after exercise in the placebo group. The ASI also decreased after exercise in the placebo group. However, these BP-lowering effects of exercise were significantly diminished by AM, particularly at the later times of the recovery period. In addition, there was a difference between the treatments in ASI changes, but not in HR and BL changes. Conclusion: These findings demonstrate that AM usage after exercise can attenuate the beneficial effects of exercise on BP and the vasculature.


post-exercise hypotension; antibacterial mouthwash; arterial stiffness

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Yerim Choi,Min-gyeong Kang,Seung Kyum Kim. Influence of antibacterial mouthwash on post-exercise hypotension. Journal of Men's Health. 2022. 18(5);1-7.


[1] O’Donnell MJ, Xavier D, Liu L, Zhang H, Chin SL, Rao-Melacini P, et al. Risk factors for ischaemic and intracere-bral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. The Lancet. 2010; 376: 112–123.

[2] World Health Organization. A global brief on hypertension: silent killer, global public health crisis: World Health Day 2013. 2013. Available at: tem/a-global-brief-on-hypertension-silent-killer-global-public- health-crisis-world-health-day-2013 (Accessed: 19 October 2021).

[3] World Health Organization. Global status report on noncommu-nicable diseases 2014. 2014. Available at: ris/handle/10665/148114 (Accessed: 19 October 2021).

[4] Yap YG, Duong T, Bland JM, Malik M, Torp-Pederson C, Køber L, et al. Prognostic value of blood pressure measured during hos-pitalization after acute myocardial infarction: an insight from survival trials. Journal of Hypertension. 2007; 25: 307–313.

[5] Sharman JE, La Gerche A, Coombes JS. Exercise and cardio-vascular risk in patients with hypertension. American Journal of Hypertension. 2014; 28: 147–158.

[6] Chen C, Bonham AC. Postexercise hypotension: central mech-anisms. Exercise and Sport Sciences Reviews. 2010; 38: 122–127.

[7] Halliwill JR. Mechanisms and Clinical Implications of Post-exercise Hypotension in Humans. Exercise and Sport Sciences Reviews. 2001; 29: 65–70.

[8] Green DJ, Maiorana A, O’Driscoll G, Taylor R. Effect of ex-ercise training on endothelium-derived nitric oxide function in humans. The Journal of Physiology. 2005; 561: 1–25.

[9] Förstermann U, Sessa WC. Nitric oxide synthases: regulation and function. European Heart Journal. 2012; 33: 829–837d.

[10] Moretti C, Zhuge Z, Zhang G, Haworth SM, Paulo LL, Guimarães DD, et al. The obligatory role of host microbiota in bioactivation of dietary nitrate. Free Radical Biology and Medicine. 2019; 145: 342–348.

[11] Lundberg JO, Weitzberg E, Gladwin MT. The nitrate–nitrite–nitric oxide pathway in physiology and therapeutics. Nature Re-views Drug Discovery. 2008; 7: 156–167.

[12] Qin L, Liu X, Sun Q, Fan Z, Xia D, Ding G, et al. Sialin (SLC17a5) functions as a nitrate transporter in the plasma mem-brane. Proceedings of the National Academy of Sciences. 2012; 109: 13434–13439.

[13] Lundberg JO, Govoni M. Inorganic nitrate is a possible source for systemic generation of nitric oxide. Free Radical Biology and Medicine. 2004; 37: 395–400.

[14] Maron BA, Tang S, Loscalzo J. S-nitrosothiols and the S-nitrosoproteome of the cardiovascular system. Antioxidants & Redox Signaling. 2013; 18: 270–287.

[15] Divakaran S, Loscalzo J. The Role of Nitroglycerin and other Nitrogen Oxides in Cardiovascular Therapeutics. Journal of the American College of Cardiology. 2017; 70: 2393–2410.

[16] Rosenberg M. The science of bad breath. Scientific American. 2002; 286: 72–79.

[17] Govoni M, Jansson EA, Weitzberg E, Lundberg JO. The increase in plasma nitrite after a dietary nitrate load is markedly atten-uated by an antibacterial mouthwash. Nitric Oxide. 2008; 19: 333–337.

[18] Bondonno CP, Liu AH, Croft KD, Considine MJ, Puddey IB, Woodman RJ, et al. Antibacterial mouthwash blunts oral nitrate reduction and increases blood pressure in treated hypertensive men and women. American Journal of Hypertension. 2014; 28: 572–575.

[19] Cutler C, Kiernan M, Willis JR, Gallardo-Alfaro L, Casas-Agustench P, White D, et al. Post-exercise hypotension and skeletal muscle oxygenation is regulated by nitrate-reducing ac-tivity of oral bacteria. Free Radical Biology and Medicine. 2019; 143: 252–259.

[20] Brookes ZLS, Bescos R, Belfield LA, Ali K, Roberts A. Current uses of chlorhexidine for management of oral disease: a narra-tive review. Journal of Dentistry. 2020; 103: 103497.

[21] Food and Drug Administration. Oral Health Care Drug Prod-ucts for Over-the-Counter Human Use: tentative final mono-graph: notice of proposed rulemaking. Federal Register. 1988; 53: 2436–2461.

[22] Cortellini P, Labriola A, Zambelli R, Prato GP, Nieri M, Tonetti MS. Chlorhexidine with an anti discoloration system after peri-odontal flap surgery: a cross-over, randomized, triple-blind clin-ical trial. Journal of Clinical Periodontology. 2008; 35: 614–620.

[23] Mauland EK, Preus HR, Aass AM. Comparison of commercially available 0.2

[24] Fiorillo L. Chlorhexidine Gel Use in the Oral District: a System-atic Review. Gels. 2019; 5: 31.

[25] Sheen S, Addy M. An in vitro evaluation of the availability of cetylpyridinium chloride and chlorhexidine in some com-mercially available mouthrinse products. British Dental Journal. 2003; 194: 207–210.

[26] McLester CN, Nickerson BS, Kliszczewicz BM, McLester JR. Reliability and Agreement of Various InBody Body Composi-tion Analyzers as Compared to Dual-Energy X-Ray Absorp-tiometry in Healthy Men and Women. Journal of Clinical Den-sitometry. 2020; 23: 443–450.

[27] Shin Y, Ham J, Cho H. Experimental study of thermal com-fort based on driver physiological signals in cooling mode under summer conditions. Applied Sciences, 2021; 11: 845.

[28] Takazawa K, Tanaka N, Fujita M, Matsuoka O, Saiki T, Aikawa M, et al. Assessment of vasoactive agents and vascular aging by the second derivative of photoplethysmogram waveform. Hy-pertension. 1998; 32: 365–370.

[29] MacDonald JR. Potential causes, mechanisms, and implications of post exercise hypotension. Journal of Human Hypertension. 2002; 16: 225–236.

[30] Halliwill JR, Buck TM, Lacewell AN, Romero SA. Postexercise hypotension and sustained postexercise vasodilatation: what happens after we exercise? Experimental Physiology. 2013; 98: 7–18.

[31] Jones AM, Vanhatalo A, Seals DR, Rossman MJ, Piknova B, Jonvik KL. Dietary Nitrate and Nitric Oxide Metabolism: Mouth, Circulation, Skeletal Muscle, and Exercise Performance. Medicine & Science in Sports & Exercise. 2021; 53: 280–294.

[32] Koch CD, Gladwin MT, Freeman BA, Lundberg JO, Weitzberg E, Morris A. Enterosalivary nitrate metabolism and the micro-biome: Intersection of microbial metabolism, nitric oxide and diet in cardiac and pulmonary vascular health. Free Radical Bi-ology and Medicine. 2017; 105: 48–67.

[33] Miyoshi M, Kasahara E, Park A, Hiramoto K, Minamiyama Y, Takemura S, et al. Dietary nitrate inhibits stress-induced gastric mucosal injury in the rat. Free Radical Research. 2003; 37: 85–90.

[34] Kaess BM, Rong J, Larson MG, Hamburg NM, Vita JA, Levy D, et al. Aortic stiffness, blood pressure progression, and incident hypertension. JAMA. 2012; 308: 875–881.

[35] Doonan RJ, Mutter A, Egiziano G, Gomez Y, Daskalopoulou SS. Differences in arterial stiffness at rest and after acute exercise between young men and women. Hypertension Research. 2013; 36: 226–231.

[36] Bellien J, Favre J, Iacob M, Gao J, Thuillez C, Richard V, et al. Arterial stiffness is regulated by nitric oxide and endothelium-derived hyperpolarizing factor during changes in blood flow in humans. Hypertension. 2010; 55: 674–680.

[37] Hasegawa N, Fujie S, Horii N, Miyamoto-Mikami E, Tsuji K, Uchida M, et al. Effects of Different Exercise Modes on Arte-rial Stiffness and Nitric Oxide Synthesis. Medicine & Science in Sports & Exercise. 2018; 50: 1177–1185.

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