LETTER TO THE EDITOR
Pathogen Burden and Hypertension: More Questions
Than Answers
Eleni Gavriilaki,1 Dimitrios Chatzidimitriou,2 Fani Chatzopoulou,2 Eugenia Gkaliagkousi,1 and
Stella Douma1
To the Editor: We read with great there is accumulating cross-sectional hypertension and atherosclerosis.
interest the article “Association of and epidemiological evidence associ- Thus, prospective studies evaluating
Pathogen Burden and Hypertension: ating chronic periodontitis not only the coexistence of a number of patho-
The Persian Gulf Healthy Heart Study” with elevated blood pressure levels but gens that have been involved in ath-
by Vahdat et al.1 Although the authors also with target organ damage.2 Thus, it erosclerosis (C. pneumoniae, H.pylori,
of this well-conducted study negate would be really interesting to assess the cytomegalovirus, herpes simplex virus,
the association between pathogen coexistence of periodontal pathogens in Porphyromonas gingivalis, Epstein–
burden and hypertension, we believe the study’s population. Barr virus, Hemophilus influenzae,
that some additional issues need to be Second, the authors provide no data Mycoplasma pneumoniae, influenza
clarified. regarding hypertension stage, manage- A virus, hepatitis C virus, human
First, the role of periodontal patho- ment, and control or target organ dam- immunodeficiency virus3) based on
gens, which have been widely inves- age in their population. Assessment of serological, histopathological, and
tigated for their involvement in atherosclerosis and vascular dysfunc- molecular detection are warranted.
hypertension and atherosclerosis,2 is tion would also provide additional Beyond that, the possible therapeu-
totally ignored by the authors. In par- insight into the contribution of patho- tic role of antibiotics and or antivirals
ticular, Porphyromonas gingivalis is gen to atherosclerosis. needs to be further investigated in well-
currently accepted as a pathogen that Third, we should take into consid- designed interventional studies.
possibly contributes to pathogen bur- eration that Helicobacter pylori, cyto-
den in atherosclerosis.3 Furthermore, megalovirus, and the coexistence of
H. pylori and Chlamydia pneumoniae
were significantly associated with
Correspondence: Eleni Gavriilaki (elenicelli@ hypertension after adjustment for tra- REFERENCES
yahoo.gr). ditional cardiovascular risk factors in
12nd Propedeutic Department of Internal 1. Vahdat K, Pourbehi MR, Ostovar A, Hadavand
this study. Therefore, one cannot refute F, Bolkheir A, Assadi M, Farrokhnia M,
Medicine, Aristotle University of Thessaloniki,
Thessaloniki, Greece; 2Department of
the notion of pathogen burden involve- Nabipour I. Association of pathogen bur-
Microbiology, Aristotle University of ment in hypertension based on the den and hypertension: the Persian Gulf
Thessaloniki, Thessaloniki, Greece. results of this study. The coexistence of Healthy Heart Study. Am J Hypertens 2013;
26:1140–1147.
Initially submitted September 2, 2013; date H. pylori and C. pneumoniae, together 2. Tsioufis C, Kasiakogias A, Thomopoulos C,
of first revision September 6, 2013; accepted with other bacterial or viral patho- Stefanadis C. Periodontitis and blood pres-
for publication September 6, 2013; online gens, may have been associated with sure: the concept of dental hypertension.
publication October 10, 2013. hypertension. Atherosclerosis 2011; 219:1–9.
doi:10.1093/ajh/hpt184 In conclusion, the study by Vahdat 3. Chatzidimitriou D, Kirmizis D, Gavriilaki
E, Chatzidimitriou M, Malisiovas N.
© American Journal of Hypertension, Ltd 2013. et al. provides more questions than Atherosclerosis and infection: is the
All rights reserved. For Permissions, please answers regarding the controver- jury still not in? Future Microbiol 2012;
email: sial issue of infectious burden in 7:1217–1230.
American Journal of Hypertension 26(12) December 2013 1459
Pathogen Burden and Hypertension: More Questions
Than Answers
Eleni Gavriilaki,1 Dimitrios Chatzidimitriou,2 Fani Chatzopoulou,2 Eugenia Gkaliagkousi,1 and
Stella Douma1
To the Editor: We read with great there is accumulating cross-sectional hypertension and atherosclerosis.
interest the article “Association of and epidemiological evidence associ- Thus, prospective studies evaluating
Pathogen Burden and Hypertension: ating chronic periodontitis not only the coexistence of a number of patho-
The Persian Gulf Healthy Heart Study” with elevated blood pressure levels but gens that have been involved in ath-
by Vahdat et al.1 Although the authors also with target organ damage.2 Thus, it erosclerosis (C. pneumoniae, H.pylori,
of this well-conducted study negate would be really interesting to assess the cytomegalovirus, herpes simplex virus,
the association between pathogen coexistence of periodontal pathogens in Porphyromonas gingivalis, Epstein–
burden and hypertension, we believe the study’s population. Barr virus, Hemophilus influenzae,
that some additional issues need to be Second, the authors provide no data Mycoplasma pneumoniae, influenza
clarified. regarding hypertension stage, manage- A virus, hepatitis C virus, human
First, the role of periodontal patho- ment, and control or target organ dam- immunodeficiency virus3) based on
gens, which have been widely inves- age in their population. Assessment of serological, histopathological, and
tigated for their involvement in atherosclerosis and vascular dysfunc- molecular detection are warranted.
hypertension and atherosclerosis,2 is tion would also provide additional Beyond that, the possible therapeu-
totally ignored by the authors. In par- insight into the contribution of patho- tic role of antibiotics and or antivirals
ticular, Porphyromonas gingivalis is gen to atherosclerosis. needs to be further investigated in well-
currently accepted as a pathogen that Third, we should take into consid- designed interventional studies.
possibly contributes to pathogen bur- eration that Helicobacter pylori, cyto-
den in atherosclerosis.3 Furthermore, megalovirus, and the coexistence of
H. pylori and Chlamydia pneumoniae
were significantly associated with
Correspondence: Eleni Gavriilaki (elenicelli@ hypertension after adjustment for tra- REFERENCES
yahoo.gr). ditional cardiovascular risk factors in
12nd Propedeutic Department of Internal 1. Vahdat K, Pourbehi MR, Ostovar A, Hadavand
this study. Therefore, one cannot refute F, Bolkheir A, Assadi M, Farrokhnia M,
Medicine, Aristotle University of Thessaloniki,
Thessaloniki, Greece; 2Department of
the notion of pathogen burden involve- Nabipour I. Association of pathogen bur-
Microbiology, Aristotle University of ment in hypertension based on the den and hypertension: the Persian Gulf
Thessaloniki, Thessaloniki, Greece. results of this study. The coexistence of Healthy Heart Study. Am J Hypertens 2013;
26:1140–1147.
Initially submitted September 2, 2013; date H. pylori and C. pneumoniae, together 2. Tsioufis C, Kasiakogias A, Thomopoulos C,
of first revision September 6, 2013; accepted with other bacterial or viral patho- Stefanadis C. Periodontitis and blood pres-
for publication September 6, 2013; online gens, may have been associated with sure: the concept of dental hypertension.
publication October 10, 2013. hypertension. Atherosclerosis 2011; 219:1–9.
doi:10.1093/ajh/hpt184 In conclusion, the study by Vahdat 3. Chatzidimitriou D, Kirmizis D, Gavriilaki
E, Chatzidimitriou M, Malisiovas N.
© American Journal of Hypertension, Ltd 2013. et al. provides more questions than Atherosclerosis and infection: is the
All rights reserved. For Permissions, please answers regarding the controver- jury still not in? Future Microbiol 2012;
email: sial issue of infectious burden in 7:1217–1230.
American Journal of Hypertension 26(12) December 2013 1459
