Is There an Association between Periodontitis and Hypertension?
Mara Lucia Macedo Paizan and Jose Fernando Vilela-Martin
Affiliation: Av Brig Faria Lima 5416, Postal Code: 15090-000, Sao Jose do Rio Preto/Sao Paulo, Brazil.
Keywords: Atherogenesis, cardiovascular disease, cardiovascular risk, hypertension, metabolic syndrome, oxidative stress,
periodontal disease, periodontitis.
Cardiovascular diseases are the leading cause of deaths. Also, cardiovascular risk factors start the atherosclerotic
process, which leads to cardiovascular diseases. Nowadays, periodontal disease can also be considered another cardiovascular
risk factor. It involves inflammatory, immunological and humoral activities, which induce the production of
proinflammatory cytokines and the destruction of the epithelium. This allows the entry of endotoxins and exotoxins in the
bloodstream, which may contribute to atherogenesis and thromboembolic events. There is also direct invasion of the vessel
wall by oral pathogens, triggering an inflammatory response that produces endothelial dysfunction. In hypertension,
changes in microcirculation can cause ischemia in the periodontium, which favors periodontal disease. Moreover, endothelial
dysfunction promotes the formation of atherosclerotic plaque and the development of lesions in target organs. Periodontitis
has also been associated with insulin resistance and a higher risk for the metabolic syndrome, which is characterized
by oxidative stress. This seems to act as a common link to explain the relationship between each component of the
metabolic syndrome (including hypertension) and periodontitis. This article will discuss clinical and experimental evidence,
as well as possible pathophysiologic mechanisms and links involved in the relationship among periodontal disease,
hypertension and cardiovascular disease.
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