Clinical & Experimental Cardiology
Open Access

Arterial Hypertension, Morbid Obesity and Periodontal Diseases in Patients Who are Candidates for Bariatric Surgery: Exploring the Role of Inflammation

Silvia Helena de Carvalho Sales-Peres^{* *}Correspondence: Silvia Helena de Carvalho Sales-Peres, Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil, Email:

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Description

Obesity is a chronic inflammatory disease and defined as a state of abnormal or excessive accumulation of adipose tissue that leads to health risks. It is often a major risk factor for the development of several non-communicable diseases, such as cardiovascular disease, dyslipidemia, arterial hypertension, type II diabetes mellitusand premature death [1].

There is scientific evidence that arterial hypertension is related to vascular inflammation and endothelial dysfunction [2]. Vascular inflammation occurs through the inflammatory mediators that increase vascular permeability and changes in the cytoskeleton of endothelial cells, which in turnleading to an imbalance between vasodilation and vasoconstriction. The active involvement of inflammatory mediators’ advance vasoconstriction is more intense, inducing an increase in blood pressure. Further, the C-reactive protein plays an important role in this process [3].

The arterial hypertension and obesity are affected by similar mechanism, such as eating habits, glomerular filtration, and metabolic and neuroendocrine disorders.Hypertension is a result of a complex relationship of multiple neurohormonal factors. The physiologic mechanisms of this condition involve hormones, cytokines, adipokines, and gut peptides implicated in its development [4].

Oral diseases may have systemic effects. Periodontal disease has been suggested as a risk factor for stroke, coronary heart disease, peripheral arterial disease, and hypertension [5]. Inflammatory state leads to abdominal obesity, dyslipidemia, insulin resistance and periodontal disease. The adipose tissue secretes numerous immunomodulatory factors as adipokines, which play a role in regulating vascular and metabolic biology. Metabolites abnormal levels from adipose tissue also adipose tissues secrete cytokines such as interleukin 6 (IL-6) andtumor necrosis factor alpha (TNFα) [6] the last one is associated with inflammation of the periodontium, leading to the destruction of alveolar bone in periodontal tissues [7]. A pathophysiological has linked of periodontitis to hypertension and the causal relation has been considered to be both direct and indirect [5].

Considering that periodontitis and arterial hypertension share common risk factors, such as obesity, the confounding factors must be controlled in assessing the association of outcomes. A metaanalysis demonstrated that periodontal disease is associated with an increased risk of high blood pressure, although their findings were highly heterogeneous, and there was no clarity regarding the causal direction in the association of these conditions [2]. These findings were confirmed in another systematic review concerning an increased prevalence of periodontitis in patients with hypertension [8].

The patients affected by morbid obesity diagnosed with arterial hypertensionare at high risk of developing cardiovascular diseases based on the accumulation of abdominal fat, gender, and age. Also, they have a higher prevalence of periodontitis and greater disease severity than morbidly obese people without arterial hypertension [3].

Conclusion

We may highlight that obesity, hypertension and periodontal disease are significant healthcare and exhibit the necessity to investments in prevention and health education, multidisciplinary, comprehensive and equitable treatment of morbidly obese patients who are candidates to bariatric surgery, especially those in vulnerable situations.

Competing Interests

There are no competing interests associated with the manuscript.

Funding

This work was partially supported by Coordination for the Improvement of Higher Education Personnel (CAPES-Finance Code 001).

Acknowledgments

This study was funded by the Coordination of Improvement of Higher Level Personnel (CAPES-Finance Code 001), regulated by the Ministry of Education, Brazil.

References

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