Purpose <p>The aim of this study was to update the association between periodontitis and hypertension.</p> Methods <p>A comprehensive literature search was conducted in the MEDLINE/PubMed, Web of Science, Scopus and Google Scholar databases to evaluate the association between periodontitis and hypertension up until May 2025. All observational studies, including cross-sectional, case-control, and cohort studies, were included. Two researchers independently conducted the screening of studies, data extraction, and quality assessment. Heterogeneity between studies was assessed using the Q-test (chi-square) and the I-squared statistic. A random-effects model/ fixed-effect model was applied to pool the effect sizes. The subgroup meta-analysis between periodontitis and hypertension was performed based on periodontitis indices, including probing depth (PD), clinical attachment loss (CAL), and their combination.</p> Results <p>Out of 2,145 studies identified in the initial search, 72 were included in the systematic review, and 60 were included in the meta-analysis. In random-effect meta-analysis, periodontitis increased significantly the odds of hypertension according to the PD index (OR: 1.33, 95% CI: 1.22–1.45)), the CAL index (OR: 1.62 (1.12–2.36)), and their combination (OR: 1.62 (1.29–2.03)). Moreover, the mean diastolic blood pressure was significantly higher in individuals with periodontitis than in those without periodontitis based on the PD–CAL index (MD: 5.40 (5.38–5.41)).</p> Conclusion <p>This study provided evidence of a significant association between periodontitis and hypertension. Incorporating regular periodontal evaluations into patient care may contribute to better hypertension management and potentially reduce the risk of developing hypertension.</p>