title: Is there an association between periodontitis and hypertension?
abstract: 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.
authors.forename: Mara Lúcia
authors.initials: ML
authors.lastname: Macedo Paizan
authors.affiliation: Av Brig Faria Lima 5416, Postal Code: 15090-000, Sao Jose do Rio Preto/Sao Paulo, Brazil. vilelamartin@uol.com.br.
authors.forename: José Fernando
authors.initials: JF
authors.lastname: Vilela-Martin
mesh_terms: D050197:Atherosclerosis / Q000209:etiology / Q000503:physiopathology; D002318:Cardiovascular Diseases / Q000150:complications* / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000209:etiology / Q000503:physiopathology; D007333:Insulin Resistance; D024821:Metabolic Syndrome / Q000209:etiology / Q000503:physiopathology; D018384:Oxidative Stress; D010510:Periodontal Diseases / Q000150:complications / Q000503:physiopathology; D010518:Periodontitis / Q000150:complications* / Q000209:etiology / Q000503:physiopathology; D010519:Periodontium / Q000473:pathology; D012307:Risk Factors
references.citation: Ann Periodontol. 2001 Dec;6(1):30-40
references.pmid: 11887469
references.citation: J Periodontal Res. 2009 Aug;44(4):452-8
references.pmid: 18973519
references.citation: N Engl J Med. 2007 Mar 1;356(9):911-20
references.pmid: 17329698
references.citation: Arq Bras Cardiol. 2010 Jan;94(1):79-85
references.pmid: 20414530
references.citation: Atherosclerosis. 2010 Jan;208(1):258-63
references.pmid: 19646696
references.citation: ScientificWorldJournal. 2014 Jan 08;2014:768237
references.pmid: 24526921
references.citation: N Engl J Med. 1986 Feb 20;314(8):488-500
references.pmid: 3511384
references.citation: J Periodontal Res. 2003 Jun;38(3):269-75
references.pmid: 12753364
references.citation: J Periodontal Res. 1994 Jan;29(1):62-9
references.pmid: 8113953
references.citation: Circulation. 2012 May 22;125(20):2520-44
references.pmid: 22514251
references.citation: J Periodontol. 2009 May;80(5):786-91
references.pmid: 19405832
references.citation: J Clin Periodontol. 2010 Oct;37(10):881-7
references.pmid: 20718895
references.citation: Thromb Res. 2011 Jan;127(1):e20-6
references.pmid: 21106229
references.citation: J Clin Periodontol. 2010 Jul;37(7):601-8
references.pmid: 20492076
references.citation: Infect Immun. 2002 Jan;70(1):257-67
references.pmid: 11748191
references.citation: Arq Bras Cardiol. 2010 Apr;94(4):519-26
references.pmid: 20339819
references.citation: Atherosclerosis. 2008 Jan;196(1):59-67
references.pmid: 17374371
references.citation: J Hypertens. 2010 Dec;28(12):2386-93
references.pmid: 20706132
references.citation: J Clin Periodontol. 2004 Jul;31(7):515-21
references.pmid: 15191586
references.citation: Eur J Vasc Endovasc Surg. 2008 Feb;35(2):153-8
references.pmid: 17964192
references.citation: JAMA. 2003 Dec 10;290(22):2945-51
references.pmid: 14665655
references.citation: J Dent Res. 2010 Nov;89(11):1241-6
references.pmid: 20739696
references.citation: J Gen Intern Med. 2008 Dec;23(12):2079-86
references.pmid: 18807098
references.citation: J Periodontol. 2010 Apr;81(4):512-9
references.pmid: 20367094
references.citation: Ann Periodontol. 1998 Jul;3(1):151-60
references.pmid: 9722699
references.citation: Nutr Metab (Lond). 2012 Sep 25;9(1):88
references.pmid: 23009606
references.citation: Circulation. 2005 Oct 4;112(14):2193-200
references.pmid: 16186422
references.citation: Circulation. 2013 Jan 1;127(1):e6-e245
references.pmid: 23239837
references.citation: J Clin Endocrinol Metab. 2013 Mar;98(3):913-20
references.pmid: 23386648
references.citation: J Periodontal Res. 2009 Aug;44(4):434-42
references.pmid: 19210335
references.citation: Ann Periodontol. 1998 Jul;3(1):51-61
references.pmid: 9722690
references.citation: Arq Bras Cardiol. 2010 Jul;95(1 Suppl):1-51
references.pmid: 21085756
references.citation: J Public Health Dent. 2009 Fall;69(4):248-53
references.pmid: 19453864
references.citation: BMJ. 1993 Mar 13;306(6879):688-91
references.pmid: 8471920
references.citation: J Clin Periodontol. 2008 Apr;35(4):277-90
references.pmid: 18294231
references.citation: J Periodontal Res. 2008 Jun;43(3):275-8
references.pmid: 18447854
references.citation: N Engl J Med. 1995 Nov 23;333(21):1392-400
references.pmid: 7477121
references.citation: Arterioscler Thromb Vasc Biol. 2003 Jul 1;23(7):1245-9
references.pmid: 12763762
references.citation: Thromb Haemost. 2004 Aug;92(2):244-52
references.pmid: 15269819
references.citation: J Clin Periodontol. 2009 Mar;36(3):204-11
references.pmid: 19236533
references.citation: J Clin Periodontol. 2007 Jul;34(7):574-80
references.pmid: 17535288
references.citation: Oral Surg Oral Med Oral Pathol. 1978 Oct;46(4):576-82
references.pmid: 280849
references.citation: Am Heart J. 1999 Sep;138(3 Pt 2):211-9
references.pmid: 10467215
references.citation: J Clin Periodontol. 2010 Oct;37(10):875-80
references.pmid: 20796107
references.citation: Hypertension. 2004 Sep;44(3):248-52
references.pmid: 15262903
references.citation: Atherosclerosis. 2011 Nov;219(1):1-9
references.pmid: 21640351
references.citation: Am J Hypertens. 2009 Feb;22(2):203-7
references.pmid: 19039308
references.citation: Stroke. 2003 Jan;34(1):47-52
references.pmid: 12511749
references.citation: J Periodontol. 2009 Jan;80(1):130-9
references.pmid: 19228099
references.citation: Ann Periodontol. 2001 Dec;6(1):9-15
references.pmid: 11887476
references.citation: Int J Immunopathol Pharmacol. 2012 Jan-Mar;25(1):9-17
references.pmid: 22507312
references.citation: Am J Hypertens. 2004 Jul;17(7):568-73
references.pmid: 15233975
references.citation: Arterioscler Thromb Vasc Biol. 2005 Mar;25(3):e17-8
references.pmid: 15662025
references.citation: Hypertension. 2003 Mar;41(3):488-92
references.pmid: 12623948
references.citation: J Periodontol. 2006 Jul;77(7):1173-8
references.pmid: 16805679
references.citation: Hypertension. 2004 Jun;43(6):1297-300
references.pmid: 15117916
references.citation: Blood Press. 2005;14(1):53-8
references.pmid: 15823948
references.citation: JAMA. 2000 Sep 20;284(11):1406-10
references.pmid: 10989403
references.citation: Hypertension. 2008 Feb;51(2):446-53
references.pmid: 18039979
references.citation: Am Heart J. 2007 Nov;154(5):830-7
references.pmid: 17967586
references.citation: J Periodontol. 2000 Oct;71(10):1528-34
references.pmid: 11063384
references.citation: J Hypertens. 2010 Jul;28(7):1413-21
references.pmid: 20453665
references.citation: J Periodontal Res. 2004 Dec;39(6):442-6
references.pmid: 15491349
references.citation: Periodontol 2000. 2002;29:31-69
references.pmid: 12102702
references.citation: J Hypertens. 2006 Jul;24(7):1257-63
references.pmid: 16794473