Association between Hypertension and Periodontitis: Possible Mechanisms
Identifieur interne : 000771 ( Pmc/Curation ); précédent : 000770; suivant : 000772Association between Hypertension and Periodontitis: Possible Mechanisms
Auteurs : Xin-Fang Leong [Malaisie] ; Chun-Yi Ng [Malaisie] ; Baharin Badiah [Malaisie] ; Srijit Das [Malaisie]Source :
- The Scientific World Journal [ 2356-6140 ] ; 2014.
Abstract
This review is to examine the current literatures on the relationship between periodontitis and hypertension as well as to explore the possible biological pathways underlying the linkage between these health conditions. Hypertension is one of the major risk factors for cardiovascular diseases. Oxidative stress and endothelial dysfunction are among the critical components in the development of hypertension. Inflammation has received much attention recently and may contribute to a pivotal role in hypertension. Periodontitis, a chronic low-grade inflammation of gingival tissue, has been linked to endothelial dysfunction, with blood pressure elevation and increased mortality risk in hypertensive patients. Inflammatory biomarkers are increased in hypertensive patients with periodontitis. Over the years, various researches have been performed to evaluate the involvement of periodontitis in the initiation and progression of hypertension. Many cross-sectional studies documented an association between hypertension and periodontitis. However, more well-designed prospective population trials need to be carried out to ascertain the role of periodontitis in hypertension.
Url:
DOI: 10.1155/2014/768237
PubMed: 24526921
PubMed Central: 3910336
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Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="I2">Department of Clinical Oral Biology, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia</nlm:aff><country xml:lang="fr">Malaisie</country><wicri:regionArea>Department of Clinical Oral Biology, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur</wicri:regionArea></affiliation></author><author><name sortKey="Ng, Chun Yi" sort="Ng, Chun Yi" uniqKey="Ng C" first="Chun-Yi" last="Ng">Chun-Yi Ng</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia</nlm:aff><country xml:lang="fr">Malaisie</country><wicri:regionArea>Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur</wicri:regionArea></affiliation></author><author><name sortKey="Badiah, Baharin" sort="Badiah, Baharin" uniqKey="Badiah B" first="Baharin" last="Badiah">Baharin Badiah</name><affiliation wicri:level="1"><nlm:aff id="I3">Department of Periodontology, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia</nlm:aff><country xml:lang="fr">Malaisie</country><wicri:regionArea>Department of Periodontology, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur</wicri:regionArea></affiliation></author><author><name sortKey="Das, Srijit" sort="Das, Srijit" uniqKey="Das S" first="Srijit" last="Das">Srijit Das</name><affiliation wicri:level="1"><nlm:aff id="I4">Department of Anatomy, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia</nlm:aff><country 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Hypertension is one of the major risk factors for cardiovascular diseases. Oxidative stress and endothelial dysfunction are among the critical components in the development of hypertension. Inflammation has received much attention recently and may contribute to a pivotal role in hypertension. Periodontitis, a chronic low-grade inflammation of gingival tissue, has been linked to endothelial dysfunction, with blood pressure elevation and increased mortality risk in hypertensive patients. Inflammatory biomarkers are increased in hypertensive patients with periodontitis. Over the years, various researches have been performed to evaluate the involvement of periodontitis in the initiation and progression of hypertension. Many cross-sectional studies documented an association between hypertension and periodontitis. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">ScientificWorldJournal</journal-id><journal-id journal-id-type="iso-abbrev">ScientificWorldJournal</journal-id><journal-id journal-id-type="publisher-id">TSWJ</journal-id><journal-title-group><journal-title>The Scientific World Journal</journal-title></journal-title-group><issn pub-type="ppub">2356-6140</issn><issn pub-type="epub">1537-744X</issn><publisher><publisher-name>Hindawi Publishing Corporation</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">24526921</article-id><article-id pub-id-type="pmc">3910336</article-id><article-id pub-id-type="doi">10.1155/2014/768237</article-id><article-categories><subj-group subj-group-type="heading"><subject>Review Article</subject></subj-group></article-categories><title-group><article-title>Association between Hypertension and Periodontitis: Possible Mechanisms</article-title></title-group><contrib-group><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0002-3838-9141</contrib-id><name><surname>Leong</surname><given-names>Xin-Fang</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref><xref ref-type="aff" rid="I2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0002-6066-6897</contrib-id><name><surname>Ng</surname><given-names>Chun-Yi</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Badiah</surname><given-names>Baharin</given-names></name><xref ref-type="aff" rid="I3"><sup>3</sup></xref></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0001-8302-7257</contrib-id><name><surname>Das</surname><given-names>Srijit</given-names></name><xref ref-type="aff" rid="I4"><sup>4</sup></xref><xref ref-type="corresp" rid="cor1">*</xref></contrib></contrib-group><aff id="I1"><sup>1</sup>Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia</aff><aff id="I2"><sup>2</sup>Department of Clinical Oral Biology, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia</aff><aff id="I3"><sup>3</sup>Department of Periodontology, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia</aff><aff id="I4"><sup>4</sup>Department of Anatomy, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia</aff><author-notes><corresp id="cor1">*Srijit Das: <email>drsrijit@gmail.com</email></corresp><fn fn-type="other"><p>Academic Editors: K. Nagano and I. Tomas</p></fn></author-notes><pub-date pub-type="collection"><year>2014</year></pub-date><pub-date pub-type="epub"><day>8</day><month>1</month><year>2014</year></pub-date><volume>2014</volume><elocation-id>768237</elocation-id><history><date date-type="received"><day>9</day><month>9</month><year>2013</year></date><date date-type="accepted"><day>15</day><month>12</month><year>2013</year></date></history><permissions><copyright-statement>Copyright © 2014 Xin-Fang Leong et al.</copyright-statement><copyright-year>2014</copyright-year><license xlink:href="https://creativecommons.org/licenses/by/3.0/"><license-p>This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><p>This review is to examine the current literatures on the relationship between periodontitis and hypertension as well as to explore the possible biological pathways underlying the linkage between these health conditions. Hypertension is one of the major risk factors for cardiovascular diseases. Oxidative stress and endothelial dysfunction are among the critical components in the development of hypertension. Inflammation has received much attention recently and may contribute to a pivotal role in hypertension. Periodontitis, a chronic low-grade inflammation of gingival tissue, has been linked to endothelial dysfunction, with blood pressure elevation and increased mortality risk in hypertensive patients. Inflammatory biomarkers are increased in hypertensive patients with periodontitis. Over the years, various researches have been performed to evaluate the involvement of periodontitis in the initiation and progression of hypertension. Many cross-sectional studies documented an association between hypertension and periodontitis. However, more well-designed prospective population trials need to be carried out to ascertain the role of periodontitis in hypertension.</p></abstract></article-meta></front><floats-group><fig id="fig1" orientation="portrait" position="float"><label>Figure 1</label><caption><p>(1) Inflammatory stimuli induce the expression of cellular adhesion molecules such as vascular cell adhesion molecule-1 (VCAM-1) and intracellular adhesion molecule-1 (ICAM-1) on endothelial cells. (2) Increased VCAM-1 and ICAM-1 expressions recruit more leukocytes to the site of inflammation. (3) Leukocytes infiltration and production of cytokines lead to oxidative stress and inflammation, which result in endothelial dysfunction, affecting the balance of synthesis between vasodilators and vasoconstrictors. The imbalance favours vasoconstriction and adverse vascular remodelling, (4) consequently leading to elevation of blood pressure.</p></caption><graphic xlink:href="TSWJ2014-768237.001"></graphic></fig><table-wrap id="tab1" orientation="portrait" position="float"><label>Table 1</label><caption><p>Studies demonstrating significant association of hypertension and periodontitis.</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Study</th><th align="center" rowspan="1" colspan="1">Year</th><th align="center" rowspan="1" colspan="1">Country studied</th><th align="center" rowspan="1" colspan="1">Sample size</th><th align="center" rowspan="1" colspan="1">Type of study</th><th align="center" rowspan="1" colspan="1">Findings</th><th align="center" rowspan="1" colspan="1">Adjusted for</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Ogawa et al. [<xref rid="B44" ref-type="bibr">45</xref>]</td><td align="center" rowspan="1" colspan="1">1998</td><td align="center" rowspan="1" colspan="1">Japan </td><td align="center" rowspan="1" colspan="1">2000</td><td align="center" rowspan="1" colspan="1">Cross-sectional</td><td align="center" rowspan="1" colspan="1">Hypertensive subjects had higher CPITN </td><td align="center" rowspan="1" colspan="1">None</td></tr><tr><td align="left" colspan="7" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Angeli et al. [<xref rid="B45" ref-type="bibr">46</xref>]</td><td align="center" rowspan="1" colspan="1">2003</td><td align="center" rowspan="1" colspan="1">Italy</td><td align="center" rowspan="1" colspan="1">104</td><td align="center" rowspan="1" colspan="1">Cross-sectional</td><td align="center" rowspan="1" colspan="1">↑ SBP with ↑ periodontitis severity </td><td align="center" rowspan="1" colspan="1">None</td></tr><tr><td align="left" colspan="7" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Taguchi et al. [<xref rid="B46" ref-type="bibr">47</xref>]</td><td align="center" rowspan="1" colspan="1">2004</td><td align="center" rowspan="1" colspan="1">Japan</td><td align="center" rowspan="1" colspan="1">98</td><td align="center" rowspan="1" colspan="1">Cross-sectional </td><td align="center" rowspan="1" colspan="1">↑ SBP (<italic>P</italic> = 0.058), <break></break>↑ DBP (<italic>P</italic> = 0.021), <break></break>hypertension in subjects with missing teeth (OR: 3.59; CI: 1.1–11.7)</td><td align="center" rowspan="1" colspan="1">Obesity, hypercholesterolemia, hypertriglyceridemia</td></tr><tr><td align="left" colspan="7" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Inoue et al. [<xref rid="B47" ref-type="bibr">48</xref>]</td><td align="center" rowspan="1" colspan="1">2005</td><td align="center" rowspan="1" colspan="1">Japan</td><td align="center" rowspan="1" colspan="1">364</td><td align="center" rowspan="1" colspan="1">Cross-sectional (2 time points)</td><td align="center" rowspan="1" colspan="1">Periodontitis associated with ↑ BP and WBC count</td><td align="center" rowspan="1" colspan="1">Age, gender, BMI, smoking, drinking, hypertension, DM, WBC count</td></tr><tr><td align="left" colspan="7" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Holmlund et al. [<xref rid="B42" ref-type="bibr">42</xref>]</td><td align="center" rowspan="1" colspan="1">2006</td><td align="center" rowspan="1" colspan="1">Sweden</td><td align="center" rowspan="1" colspan="1">4254</td><td align="center" rowspan="1" colspan="1">Cross-sectional (Retrospective)</td><td align="center" rowspan="1" colspan="1">Periodontal pocket related to hypertension <break></break>(<italic>P</italic> < 0.0001), <break></break>↑ periodontitis severity with hypertension (OR: 1.32; CI: 1.13–1.54; <italic>P</italic> < 0.0005)</td><td align="center" rowspan="1" colspan="1">Age, gender, number of teeth, smoking</td></tr><tr><td align="left" colspan="7" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">D'Aiuto et al. [<xref rid="B48" ref-type="bibr">49</xref>]</td><td align="center" rowspan="1" colspan="1">2006</td><td align="center" rowspan="1" colspan="1">England</td><td align="center" rowspan="1" colspan="1">40</td><td align="center" rowspan="1" colspan="1">Prospective intervention randomized controlled trial</td><td align="center" rowspan="1" colspan="1">↓ 7 ± 3 mmHg of SBP after 2 months of intensive treatment</td><td align="center" rowspan="1" colspan="1">None</td></tr><tr><td align="left" colspan="7" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Völzke et al. [<xref rid="B49" ref-type="bibr">50</xref>] </td><td align="center" rowspan="1" colspan="1">2006</td><td align="center" rowspan="1" colspan="1">Germany</td><td align="center" rowspan="1" colspan="1">4185</td><td align="center" rowspan="1" colspan="1">Cross-sectional (SHIP)</td><td align="center" rowspan="1" colspan="1">↑ SBP (<italic>P</italic> < 0.05) and OR: 1.91 (CI: 1.21–3.02; <italic>P</italic> < 0.05) for hypertension in male with 0–6 teeth compared to fully dentate</td><td align="center" rowspan="1" colspan="1">Age, BMI, education, smoking, diet, DM, antihypertensive medication</td></tr><tr><td align="left" colspan="7" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Engström et al. [<xref rid="B43" ref-type="bibr">43</xref>]</td><td align="center" rowspan="1" colspan="1">2007</td><td align="center" rowspan="1" colspan="1">Sweden</td><td align="center" rowspan="1" colspan="1">390</td><td align="center" rowspan="1" colspan="1">Cross-sectional </td><td align="center" rowspan="1" colspan="1">DBP associated with deep periodontal pockets</td><td align="center" rowspan="1" colspan="1">Age, gender, tobacco use, number of teeth</td></tr><tr><td align="left" colspan="7" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Völzke et al. [<xref rid="B50" ref-type="bibr">51</xref>] </td><td align="center" rowspan="1" colspan="1">2007</td><td align="center" rowspan="1" colspan="1">Germany</td><td align="center" rowspan="1" colspan="1">1913</td><td align="center" rowspan="1" colspan="1">Cross-sectional (SHIP)</td><td align="center" rowspan="1" colspan="1">↑ SBP (female: 11.7 mm Hg; male: 5.7 mmHg) in edentulous compared to fully dentate</td><td align="center" rowspan="1" colspan="1">None</td></tr><tr><td align="left" colspan="7" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">O. A. Ayo-Yusuf and I. J. Ayo-Yusuf [<xref rid="B51" ref-type="bibr">52</xref>]</td><td align="center" rowspan="1" colspan="1">2008</td><td align="center" rowspan="1" colspan="1">South Africa</td><td align="center" rowspan="1" colspan="1">9098</td><td align="center" rowspan="1" colspan="1">Cross-sectional data (SADHS)</td><td align="center" rowspan="1" colspan="1">Higher SBP (12 mmHg) and DBP (5 mmHg) in complete<break></break>edentulous compared to fully dentate<break></break>OR: 1.35 (CI: 1.02–1.78) for hypertension in complete edentulous </td><td align="center" rowspan="1" colspan="1">Age, BMI, DM, education, income, diet, alcohol, smoking, family history of hypertension, oral hygiene behaviour (daily brushing, dental visits)</td></tr><tr><td align="left" colspan="7" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Franek et al. [<xref rid="B52" ref-type="bibr">53</xref>] </td><td align="center" rowspan="1" colspan="1">2009</td><td align="center" rowspan="1" colspan="1">Poland</td><td align="center" rowspan="1" colspan="1">99</td><td align="center" rowspan="1" colspan="1">Cross-sectional </td><td align="center" rowspan="1" colspan="1">Periodontitis severity associated with central BP and pulse pressure (<italic>P</italic> < 0.05) </td><td align="center" rowspan="1" colspan="1">Age, gender, BMI, hypertension duration, smoking, number of drugs taken </td></tr><tr><td align="left" colspan="7" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Fujita et al. [<xref rid="B53" ref-type="bibr">54</xref>] </td><td align="center" rowspan="1" colspan="1">2009</td><td align="center" rowspan="1" colspan="1">Japan</td><td align="center" rowspan="1" colspan="1">54551</td><td align="center" rowspan="1" colspan="1">Cross-sectional data</td><td align="center" rowspan="1" colspan="1">Female (OR: 1.52; CI: 1.14–2.03; <italic>P</italic> = 0.005); male (OR: 1.24; CI: 1.06–1.45; <italic>P</italic> = 0.006) for hypertension in no brushing compared to brushing after every meal</td><td align="center" rowspan="1" colspan="1">Age, BMI, smoking, alcohol, walking time</td></tr><tr><td align="left" colspan="7" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Nesse et al. [<xref rid="B54" ref-type="bibr">55</xref>] </td><td align="center" rowspan="1" colspan="1">2010</td><td align="center" rowspan="1" colspan="1">The Netherlands</td><td align="center" rowspan="1" colspan="1">1208</td><td align="center" rowspan="1" colspan="1">Cross-sectional</td><td align="center" rowspan="1" colspan="1">↑ hypertension prevalence in periodontitis subjects compared to controls (<italic>P</italic> = 0.001) </td><td align="center" rowspan="1" colspan="1">None </td></tr><tr><td align="left" colspan="7" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">de Oliveira et al. [<xref rid="B55" ref-type="bibr">56</xref>]</td><td align="center" rowspan="1" colspan="1">2010</td><td align="center" rowspan="1" colspan="1">Scotland</td><td align="center" rowspan="1" colspan="1">11869</td><td align="center" rowspan="1" colspan="1">Cross-sectional (Scottish Health Survey)</td><td align="center" rowspan="1" colspan="1">↑ hypertension prevalence in subject with rare teeth brushing (<italic>P</italic> < 0.001)</td><td align="center" rowspan="1" colspan="1">None</td></tr><tr><td align="left" colspan="7" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Morita et al. [<xref rid="B56" ref-type="bibr">57</xref>] </td><td align="center" rowspan="1" colspan="1">2010</td><td align="center" rowspan="1" colspan="1">Japan</td><td align="center" rowspan="1" colspan="1">1023</td><td align="center" rowspan="1" colspan="1">Prospective cohort </td><td align="center" rowspan="1" colspan="1">Periodontal pocket associated with hypertension (OR: 1.5; CI: 1.0–2.3) </td><td align="center" rowspan="1" colspan="1">Age, gender, smoking, regular exercise, eating between meals, healthy body weight</td></tr><tr><td align="left" colspan="7" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Franek et al. [<xref rid="B57" ref-type="bibr">58</xref>]</td><td align="center" rowspan="1" colspan="1">2010</td><td align="center" rowspan="1" colspan="1">Poland</td><td align="center" rowspan="1" colspan="1">155</td><td align="center" rowspan="1" colspan="1">Cross-sectional</td><td align="center" rowspan="1" colspan="1">Periodontitis severity associated with central SBP (<italic>P</italic> = 0.011) & DBP (<italic>P</italic> = 0.006) </td><td align="center" rowspan="1" colspan="1">Age, gender, BMI, hypertension and insulin treatment</td></tr><tr><td align="left" colspan="7" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Tsakos et al. [<xref rid="B58" ref-type="bibr">59</xref>] </td><td align="center" rowspan="1" colspan="1">2010</td><td align="center" rowspan="1" colspan="1">United States of America</td><td align="center" rowspan="1" colspan="1">11948</td><td align="center" rowspan="1" colspan="1">Cross-sectional data (NHANES III)</td><td align="center" rowspan="1" colspan="1">↑ SBP (<italic>P</italic> < 0.001) <break></break>OR: 1.1 (CI: 1-1.1; <italic>P</italic> < 0.05) for hypertension in ↑ 10% gingival bleeding</td><td align="center" rowspan="1" colspan="1">Age, gender, BMI, ethnicity, CRP, creatinine, Na<sup>+</sup>/K<sup>+</sup> ratio, chronic conditions, smoking, alcohol, education, income</td></tr><tr><td align="left" colspan="7" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Desvarieux et al. [<xref rid="B59" ref-type="bibr">60</xref>]</td><td align="center" rowspan="1" colspan="1">2010</td><td align="center" rowspan="1" colspan="1">United States of America</td><td align="center" rowspan="1" colspan="1">653</td><td align="center" rowspan="1" colspan="1">Cross-sectional data (INVEST)</td><td align="center" rowspan="1" colspan="1">↑ SBP & DBP<break></break>OR: 3.13 (CI: 1.62–6.03; <italic>P</italic> < 0.001) for hypertension when etiological bacterial burden is high</td><td align="center" rowspan="1" colspan="1">Age, gender, BMI, race, education, smoking, DM, LDL-C, HDL-C, nonetiological periodontal bacteria</td></tr><tr><td align="left" colspan="7" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Zhang et al. [<xref rid="B60" ref-type="bibr">61</xref>]</td><td align="center" rowspan="1" colspan="1">2011</td><td align="center" rowspan="1" colspan="1">Xinjang Uygur</td><td align="center" rowspan="1" colspan="1">1415</td><td align="center" rowspan="1" colspan="1">Cohort</td><td align="center" rowspan="1" colspan="1">Periodontitis associated with hypertension (OR: 1.75; CI: 1.30–2.36; <italic>P</italic> < 0.01) </td><td align="center" rowspan="1" colspan="1">Age, gender, BMI, waist circumference, glycometabolism disorder, hyperlipidemia, chronic kidney disease</td></tr><tr><td align="left" colspan="7" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Vidal et al. [<xref rid="B61" ref-type="bibr">62</xref>]</td><td align="center" rowspan="1" colspan="1">2011</td><td align="center" rowspan="1" colspan="1">Brazil</td><td align="center" rowspan="1" colspan="1">137</td><td align="center" rowspan="1" colspan="1">Case-control</td><td align="center" rowspan="1" colspan="1">Hypertension associated with severe chronic periodontitis (OR: 4.04; CI: 1.92–8.49), with generalized chronic periodontitis (OR: 2.18; CI: 1.04–4.56)</td><td align="center" rowspan="1" colspan="1">Gender, race, DM, alcohol, smoking</td></tr><tr><td align="left" colspan="7" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Peres et al. [<xref rid="B62" ref-type="bibr">63</xref>]</td><td align="center" rowspan="1" colspan="1">2012</td><td align="center" rowspan="1" colspan="1">Brazil</td><td align="center" rowspan="1" colspan="1">1720</td><td align="center" rowspan="1" colspan="1">Cross-sectional</td><td align="center" rowspan="1" colspan="1">Edentulous subjects had a SBP 8.3 mmHg (CI: 0.1–16.7) higher than those with 10 or more teeth in both dental arches </td><td align="center" rowspan="1" colspan="1">Age, gender, BMI, <break></break>education, income, smoking, alcohol, DM, leisure physical activity, use of dental prosthesis, self-rated health status</td></tr><tr><td align="left" colspan="7" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Rivas-Tumanyan et al. [<xref rid="B63" ref-type="bibr">64</xref>]</td><td align="center" rowspan="1" colspan="1">2013</td><td align="center" rowspan="1" colspan="1">Puerto Rica </td><td align="center" rowspan="1" colspan="1">182</td><td align="center" rowspan="1" colspan="1">Cross-sectional </td><td align="center" rowspan="1" colspan="1">Periodontitis severity associated with high BP (OR: 2.93; CI: 1.25–6.84) <break></break>OR: 4.20 (CI: 1.28–13.80) restricted to those with hypertension history and/or taking antihypertensive medications </td><td align="center" rowspan="1" colspan="1">Age, gender, smoking, drinking</td></tr></tbody></table><table-wrap-foot><fn><p>Symbols indicate: ↑: increased; ↓: decreased.</p></fn><fn><p>BMI: body mass index; CI: confidence interval; CPITN: community periodontal index of treatment needs; CRP: C-reactive protein; DBP: diastolic blood pressure; DM: diabetes mellitus; HDL-C: high-density lipoprotein cholesterol; INVEST: Oral Infections and Vascular Disease Epidemiology Study; LDL-C; low-density lipoprotein cholesterol; NHANES: National Health and Nutrition Examination Survey; OR: odds ratio; SADHS: South African Demographic and Health Survey; SBP: systolic blood pressure; SHIP: Study of Health in Pomerania; WBC: white blood cell.</p></fn></table-wrap-foot></table-wrap><table-wrap id="tab2" orientation="portrait" position="float"><label>Table 2</label><caption><p>Studies reporting inflammatory involvement in the interrelationship between hypertension and periodontitis.</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Study</th><th align="center" rowspan="1" colspan="1">Design</th><th align="center" rowspan="1" colspan="1">Periodontal evaluation</th><th align="center" rowspan="1" colspan="1">Inflammatory markers</th><th align="center" rowspan="1" colspan="1">Hypertension-related parameters</th><th align="center" rowspan="1" colspan="1">Key findings</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Higashi et al. 2009 [<xref rid="B66" ref-type="bibr">65</xref>]</td><td align="center" rowspan="1" colspan="1">Prospective</td><td align="center" rowspan="1" colspan="1">PPD<break></break>CAL<break></break>GB</td><td align="center" rowspan="1" colspan="1">CRP<break></break>IL-6</td><td align="center" rowspan="1" colspan="1">Forearm blood<break></break>flow responses <break></break>to vasoactive <break></break>substances,<break></break>SBP and <break></break>DBP</td><td align="center" rowspan="1" colspan="1">Periodontitis is associated with reduced NO bioavailability and ED, with systemic inflammation as a predictor of ED</td></tr><tr><td align="left" colspan="6" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Papapanagiotou et al. 2009 [<xref rid="B69" ref-type="bibr">66</xref>]</td><td align="center" rowspan="1" colspan="1">Case-control</td><td align="center" rowspan="1" colspan="1">Reported periodontitis</td><td align="center" rowspan="1" colspan="1">Leukocyte counts<break></break>Platelet count<break></break>CRP<break></break>P-selectin</td><td align="center" rowspan="1" colspan="1">SBP and DBP</td><td align="center" rowspan="1" colspan="1">Periodontitis is associated with platelet activation</td></tr><tr><td align="left" colspan="6" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Herrera et al. 2011 [<xref rid="B70" ref-type="bibr">67</xref>]</td><td align="center" rowspan="1" colspan="1">Experimental</td><td align="center" rowspan="1" colspan="1">X-ray bone loss assessment</td><td align="center" rowspan="1" colspan="1">MPO <break></break>TBARS<break></break>NT</td><td align="center" rowspan="1" colspan="1">NO</td><td align="center" rowspan="1" colspan="1">NO contributes to the systemic effects of periodontitis</td></tr><tr><td align="left" colspan="6" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Eder et al. 2012<break></break>[<xref rid="B71" ref-type="bibr">68</xref>]</td><td align="center" rowspan="1" colspan="1">Case-control</td><td align="center" rowspan="1" colspan="1">Radiography (WHO)</td><td align="center" rowspan="1" colspan="1">PGE<sub>2</sub>
<break></break>TXB<sub>2</sub></td><td align="center" rowspan="1" colspan="1">PGI<sub>2</sub></td><td align="center" rowspan="1" colspan="1">Presence of granuloma in periodontitis is linked to inflammation and the synthesis of metabolites of AA</td></tr><tr><td align="left" colspan="6" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Brito et al. 2013<break></break>[<xref rid="B72" ref-type="bibr">69</xref>]</td><td align="center" rowspan="1" colspan="1">Experimental</td><td align="center" rowspan="1" colspan="1">Measurement of alveolar bone loss of mandibles</td><td align="center" rowspan="1" colspan="1">Leukocyte counts<break></break>IL-6<break></break>CRP</td><td align="center" rowspan="1" colspan="1">Mean arterial pressure,<break></break>vascular reactivity</td><td align="center" rowspan="1" colspan="1">Periodontitis induces systemic and vascular inflammation which lead to ED</td></tr></tbody></table><table-wrap-foot><fn><p>AA: arachidonic acid; CAL: clinical attachment loss; CRP: C-reactive protein; DBP: diastolic blood pressure; ED: endothelial dysfunction; GB: gingival bleeding; IL: interleukin; MPO: myeloperoxidase; NO: nitric oxide; NT: nitrotyrosine-containing protein; PGE<sub>2</sub>: prostaglandin E<sub>2</sub>; PGI<sub>2</sub>: prostacyclin; PPD: probing pocket depth; SBP: systolic blood pressure; TBARS: thiobarbituric acid reactive substances; TXB<sub>2</sub>: thromboxane B<sub>2</sub>; WHO: World Health Organisation.</p></fn></table-wrap-foot></table-wrap></floats-group></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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