Parameter Age (year) BMI Total-C TG HDL-C HbA1c Periodontitis Tooth loss Versus NaCl (g/day)† KCl (g/day)† Na/K Mg (mg/day) Total-C TG HDL-C BMI HbA1c International Journal of Hypertension 3 Table 2: Multiple-regression analysis of BP, periodontitis, tooth loss, and traditional risk factors possibly related to hypertension in middle- aged women. Systolic blood pressure (mmHg) β P value 0.103 0.364 0.270 0.024† 0.074 0.602 0.187 0.545 0.081 0.165 0.259 0.190 0.288 0.018† 0.308 0.010† Diastolic blood pressure (mmHg) β P value 0.051 0.649 0.299 0.012† 0.125 0.374 0.099 0.452 −0.056 0.668 0.139 0.194 0.293 0.015† 0.417 0.0005‡ Values are regression coeﬃcients (β) and P values. †P < 0.05, ‡P < 0.001. Multiple correlation coeﬃcient |R| = 0.609 for systolic blood pressure, |R| = 0.621 for diastolic blood pressure. Table 3: Simple correlation coeﬃcients between periodontitis and tooth loss with traditional risk factors possibly related to hypertension in middle-aged women. Periodontitis r −0.179 −0.579 0.160 −0.336 0.002 −0.007 0.059 −0.160 −0.071 P value 0.329 0.0004§ 0.385 0.060 0.986 0.951 0.627 0.184 0.558 Versus NaCl (g/day) KCl (g/day) Na/K Mg (mg/day) Total-C TG HDL-C BMI HbA1c Tooth loss r −0.112 −0.204 0.081 −0.273 −0.102 −0.083 −0.114 −0.271 −0.158 P value 0.547 0.265 0.660 0.131 0.400 0.495 0.345 0.022‡ 0.189 Values are correlation coeﬃcients (r), ‡P < 0.05, §P < 0.001. 24-hour urine (n = 32), blood chemistry and BMI (n = 81), and †24-hour urinary sodium and potassium excretions were measured and the intakes were estimated as the amount of chloride salt. Next, we tested the association of periodontitis and tooth loss with traditional risk factors for HT in women (Table 3). There was a strong inverse correlation of 24-hour urinary excretion of potassium (Y ; amount estimated as KCL) with severity of periodontitis (X) (Y = 3.144−.433X; r = −0.579, and r2 = 0.34, P < 0.0004), but not with tooth loss. No other risk factors were correlated signiﬁcantly with periodontitis. On the other hand, tooth loss was signiﬁcantly correlated with BMI (r = −0.271, P = 0.022) but not with the 24-hour urinary excretion of potassium. Since 24-hour urinary excretion was closely related to dietary intake of potassium-rich vegetables and fruit [22], these results suggest that nutritional factors, particularly potassium intake, were associated with periodontitis but not with tooth loss. Therefore, we further assessed the relationship between dietary factors and periodontitis. There were signiﬁcant negative correlations of the intakes of green vegetables (r = −0.232, P = 0.031) and fruit (r = −0.217, P = 0.043) with the severity of periodontitis in women (Table 4). These results indicate that the intake of potassium-rich foods, such as green vegetables and fruit, is associated with periodontitis. The intake of skimmed milk, but not whole milk, was signiﬁcantly inversely correlated with the severity of periodontitis. This might be related to the preference for skimmed milk among vegetarians. 4. Discussion In this study, we demonstrated that periodontitis and tooth loss were signiﬁcantly associated with an increased risk of HT in middle-aged African women on no medication without any direct inﬂuence of smoking and drinking alcohol. HT is associated with increased levels of the markers of inﬂam- mation, including CRP and proinﬂammatory cytokines [6]. Periodontitis as chronic bacterial infection by Gram- negative bacteria is also associated with increased levels of inﬂammation-related markers such as CRP in circulation [3–5]. Recent studies suggest that everyday events such as chewing and brushing of teeth contribute more signiﬁcantly to the cumulative exposure of the vascular system to oral bacteria [23]. Periodontal pathogens were identiﬁed in carotid atheromatous plaques obtained by endarterectomy from patients [24]. In periodontitis, bacteremia and/or endotoxemia may trigger a systemic inﬂammatory response that, in turn, may cause endothelial dysfunction and thus increase BP and accelerate atherosclerosis.