The conjoint detrimental effect of chronic periodontal disease and systemic inflammation on asymmetric dimethyl-arginine in untreated hypertensive subjects

ObjectiveTo investigate the relationship between periodontal disease indexes (PDI) and endothelial dysfunction by means of asymmetric dimethyl-arginine (ADMA) in conditions of both increased and decreased systemic inflammation in the setting of hypertension.MethodsWe studied 108 – aged 52 ± 9 years – untreated hypertensive subjects (24 h systolic/diastolic blood pressure [BP] 131 ± 11/83 ± 9 mmHg) with diverse severity of periodontal disease (i.e. mean clinical loss of attachment, maximum probe depth and gingival index). Subjects underwent office and ambulatory BP measurements, echocardiography, periodontal examination; while from fasting venous blood samples we assessed metabolic profile, and we measured ADMA and high sensitivity C reactive protein (hsCRP) levels.ResultsWith respect to the median of hsCRP and ADMA (1.79 mg/l and 0.81 μmol/l, respectively) the study population was divided in four groups: low-ADMA/low-hsCRP (n = 30), low-ADMA/high-hsCRP (n = 27), high-ADMA/low-hsCRP (n = 21) and high-ADMA/high-hsCRP (n = 30). High-ADMA/high-hsCRP group resulted significantly older compared with both low-ADMA/low-hsCRP and high-ADMA/high-hsCRP groups, while high compared with low-ADMA groups demonstrated increased low-density lipoprotein cholesterol. PDIs were increased in those with high compared with those with low-hsCRP, while the addition of high-ADMA contributed significantly to that comparison. After adjustment for confounders, high-ADMA/high-hsCRP was significantly associated – by means of adjusted z-scores – with mean clinical loss of attachment, maximum probe depth and gingival index by 10.33, 8.84 and 2.74 times more often with respect to the low-ADMA/low-hsCRP pattern.ConclusionPDI are associated in a dose-dependent manner with ADMA in untreated hypertensives and increased systemic inflammation further contributes to that phenomenon.