Periodontitis as an inflammatory trigger in hypertension: from basic immunology to clinical implications

Szczepaniak, P., Mikołajczyk, T. P., Cześnikiewicz-Guzik, M. and Guzik, T. J. (2021) Periodontitis as an inflammatory trigger in hypertension: from basic immunology to clinical implications. Kardiologia Polska, 79(11), pp. 1206-1214. (doi: 10.33963/KP.a2021.0161) (PMID:34847238)

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Publisher's URL: https://doi.org/10.33963/KP.a2021.0161

Abstract

Hypertension and periodontitis are both highly prevalent co-morbidities worldwide, and their occurrence increases with age. Multiple observational epidemiological studies have shown that periodontitis is associated with an increased cardiovascular disease (CVD) occurrence. Large systematic reviews and metanalyses further show that periodontitis increases the risk of hypertension and is associated with increased systolic and diastolic blood pressure. Genetic and clinical evidence, utilizing mendelian randomization and randomized clinical trials, support the causal role of periodontitis in hypertension. The mechanisms of this link remain unclear. Critical components of immune and inflammatory pathogenesis of periodontitis considerably overlap with immune mechanisms of hypertension. Clinical studies support that both C-reactive protein (CRP) levels and white blood cell counts (WBC) mediate the relationship between periodontal disease and high blood pressure. In particular, activation of Th1, Th17, T regulatory cells, and proinflammatory monocytes has been shown to be essential in both conditions. Immunosenescent dysregulated CD28null T cells have been implicated, along with key effector cytokines such as interleukin 6 (IL-6), TNF-alpha (TNF-α), interferon-gamma (IFN-γ), and interleukin 17 (IL-17). A better understanding of the relationships between hypertension and periodontitis is essential not only for possible utilization of this knowledge for a non-pharmacological approach to improving blood pressure control. It may also provide valuable pathogenetic clues linking inflammation and hypertension, which has become particularly relevant in the light of links between hypertension and autoimmune disorders or, more recently, COVID-19.

Item Type:Articles
Keywords:Hypertension, periodontitis, inflammation.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Czesnikiewicz-Guzik, Dr Marta and Guzik, Professor Tomasz and Szczepaniak, Mr Piotr and Mikolajczyk, Dr Tomasz
Authors: Szczepaniak, P., Mikołajczyk, T. P., Cześnikiewicz-Guzik, M., and Guzik, T. J.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Dental School
Journal Name:Kardiologia Polska
Publisher:Wydawnictwo Via Medica
ISSN:0022-9032
ISSN (Online):1897-4279
Published Online:25 November 2021
Copyright Holders:Copyright © 2021 The Authors
First Published:First published in Kardiologia Polska 79(11): 1206-1214
Publisher Policy:Reproduced under a Creative Commons License

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