الفهرس 
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Abstract
Since periodontal disease (PD) is thought to be complex, it is essential to have a thorough awareness of all the risk factors that are involved.
Cardiovascular diseases (CVD) are the most common noncommunicable diseases (NCD) globally and represent a leading cause of death worldwide. Several modifiable conditions and unmodifiable traits contribute to the development of CVD, and high blood pressure, or hypertension, is among the major ones.
It is not clear if there is a direct and common thread between periodontitis and CVD. The inflammation link seems to be a key contributor to both, despite sharing many risk factors between PD and CVDs as smoking, educational level, socioeconomic status, obesity, and diabetes.
The objective of the present study was to correlate by means of clinical parameters the prevalence of periodontal disease in hypertensive patients, as a primary objective and the secondary objective of this study was the correlation between the degree of hypertension and the severity and extent of periodontitis.
The present study included two hundred and ten subjects, divided into three groups. group one included subjects with stage 1 hypertension, group two had stage 2 hypertension and the third group included the control subjects with normotensive or elevated blood pressure. The age and gender of each subject were recorded.
Clinical parameters assessed were the visible plaque index, clinical attachment level, pocket probing depth, percent of bleeding on probing, gingival margin, number of teeth lost and a periapical radiograph was done to aid in the grading of the periodontal disease. Data was collected and subjects were classified according to the new periodontal classification.
The data collected from the examination which were the percent of plaque, percent of bleeding on probing (BOP), mean probing depth (PD), mean clinical attachment loss (CAL) were calculated from the online periodontal chart of university of Bern. Highest reading of PD, highest reading of CAL, number of sites of PD greater than or equal to 4 mm and number of sites of CAL greater than or equal to 5 mm were calculated manually and added to the excel sheet along with the collected data.
The results of this study showed that the increasing mean age across hypertension stages showed a positive correlation between age and hypertension severity. As age increases, the likelihood of having more advanced hypertension also increases.
For generalized biofilm induced gingivitis, the percentage is slightly higher in females than males. However, there was no significant relationship between gender and this disease type and severity. For generalized periodontitis stage II grade B, the percentage is higher in males than females. Our results showed a significant association between male gender and increased severity of disease.
This pattern continues for other stages/grades. Males have higher percentages for stage II grade C, stage IV grade B, and stage IV grade C disease. Females have slightly higher rates for stage III grades B and C. For localized periodontitis stage I grade B, males and females have an equal percentage. Statistical analysis shows no association with gender for this disease type and severity. For other localized disease stages, males again show somewhat higher percentages than females.
For the probing depth, the mean values show an increasing trend from control to stage 1 hypertension to stage 2 hypertension patients. The results were highly significant. While for the CAL, the results demonstrated a correlation between hypertension severity and extent of clinical attachment loss in periodontal disease. The stage 2 hypertension group had significantly more clinical attachment loss than stage 1 and controls. Stage 1 hypertension did not differ from controls.
The data of the BOP percent demonstrated higher values correlated with increasing hypertension severity. The highest hypertension group had significantly more bleeding compared to the control group. However, differences between moderate hypertension (stage 1 and 2) and control/highest groups were less clear.
This study found a significant overall difference between groups regarding the number of lost teeth. There was no significant difference in number of teeth lost between the control and stage 1 groups). However, the stage 2 group lost significantly more teeth on average compared to the control and stage 1 groups.
For the percent of visible plaque, the control group had a significantly lower plaque percentage compared to the stage 1 and 2 hypertension groups. However, there was no significant difference in plaque index percentage between stage 1 and stage 2 hypertension.
Overall, the results of the current study showed that increased hypertension severity associated with worsening periodontal health from intact periodontium to gingivitis to periodontitis as well as more severe and extensive periodontitis among patients with hypertension compared to normotensive controls.