IS PERIODONTAL DISEASE A COMORBIDITY…?Relationship Between Periodontal Disease and Hypertension

Periodontitis and Hypertension

Hypertension is associated with PD, and these conditions occur frequently in patients with greater attachment loss. Many patients with hypertension are treated with calcium antagonists that occasionally can cause gingival hyperplasia, which again may result in increased progression of PD. Since hypertension is a treatable risk factor for CVD, it is important to identify patients with hypertension.

The relationship between hypertension and periodontitis is associated with a chronic immune–inflammatory disorder increased mainly by periodontal inflammation. First, hypertension can intensify the activation of innate and adaptive immune cells, such as monocytes, macrophages, and T and B lymphocytes. Molecules activated can damage the periodontal vasculature. On the other hand, periodontopathogens can exacerbate the inflammation cascade by activating Th1 and Th17 lymphocytes, subsequently stimulating a hypertensive state by the inflammatory mechanism. In addition, periodontitis increases levels of local and systemic inflammatory markers by promoting changes in neutrophil function, resulting in vascular and endothelial dysfunction.  In particular, the endothelial dysfunction disrupts the regulatory balance by decreasing nitric oxide and promoting an increase of interleukin-6 (IL-6), tumor necrosis factor (TNF-α), and blood levels of CRP.   

The renin–angiotensin system, in addition to controlling blood pressure, acts on periodontal tissues. Antihypertensive blockers of Ang II receptors have been effective in inhibiting the production of IL-6, TNF-α, and receptor activator of the nuclear factor kappa-Β ligand, and consequently, they reduce alveolar bone loss.

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