Various investigations by scientists and medical experts have suggested that malaria, and particularly repeated episodes, could be responsible for hypertension and other cardiovascular diseases.
A recent report in the Lancet Global Health Journal, a leading health journal, evaluated around 10 research papers by various experts linking malaria as an infectious disease with high blood pressure and other cardiovascular diseases (CVDs).
The report is titled: “Rising blood pressure: could malaria play a role?”
The new findings constitute a new advance in the field of medicine, especially in the causes of important diseases such as hypertension and cardiovascular diseases.
Research reviewed includes one by Anjana RM, Unnikrishnan R, Deepa M, et al. titled: “India Health Report on Non-Communicable Metabolic Diseases: The ICMR-INDIAB National Cross-Sectional Study (ICMR-INDIAB-17);” “Global trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1,201 population-representative studies with 104 million participants” by NCD Risk Factor Collaboration (NCD-RisC); “Prevalence of cardiovascular complications in malaria: a systematic review and elevated blood pressure among adolescents in sub-Saharan Africa: a systematic review and meta-analysis,” is co-authored by Alexander Chen, Laura Waite, and others.
This study reported that more people in sub-Saharan Africa aged between 20 and 60 years are affected by end-organ damage due to underlying hypertension than people in high-income countries.
Additionally, the Lancet Global Health Journal reports that one in 10 adolescents in sub-Saharan Africa has hypertension and, in India, one in three adults. He noted that between 2009 and 2019, a 100 percent increase in the number of people with hypertension was reported globally.
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This increase, according to the report, has been attributed to a higher prevalence of hypertension in low- and middle-income countries.
“There is a need to improve rapid detection, formal diagnosis and appropriate treatment of hypertension throughout life. A better understanding of the natural history of hypertension and end-organ damage is needed among people aged 20 to 40 years in sub-Saharan Africa,” he stated.
At the regional level, research has shown the prevalence of cardiovascular diseases in poor and middle-income countries.
In Nigeria, the most populous country in sub-Saharan Africa, there has been a worrying increase in the prevalence of cardiovascular diseases in recent years, with a 150 percent increase reported in some studies.
CVDs are considered the largest burden of non-communicable diseases.
According to this report, cardiovascular diseases account for almost 10 percent of deaths and 3.8 percent of disability-adjusted life in Nigeria, surpassing deaths caused by common infectious diseases.
Malaria in Africa, India
Each year, there are at least 200 million cases of malaria, resulting in almost half a million deaths annually and more than 90 percent of all malaria deaths occur in sub-Saharan Africa.
According to the WHO World Malaria Report 2022, there were 249 million cases of malaria in 2022, compared to 244 million cases in 2021.
The WHO added that deaths caused by malaria increased to 608,000 in 2022, up from 610,000 in 2021.
Four African countries (Nigeria, the Democratic Republic of the Congo, Uganda and Mozambique) reportedly accounted for more than half of all malaria deaths worldwide, contributing 26.8, 12.3, 5 .1 and 4.2 percent, respectively.
The disease is responsible for 11 percent of maternal deaths and 25 percent of infant deaths.
Meanwhile, India bears 1.7 percent of the global malaria burden and 85.2 percent of the burden in Southeast Asia. The country also suffers 1.2 percent of the world’s malaria deaths.
New findings
According to the new report, people in sub-Saharan Africa and India are more likely to suffer from cardiovascular disease due to malaria infection, which has been prevalent in these areas for decades.
The Lancet Global Health Journal report indicates that after reviewing the various research papers, hypertension and other cardiovascular diseases could be caused by severe and repeated exposure to malaria, especially during childhood.
However, it noted that this is more applicable to populations in rural areas in low- and middle-income countries, such as India and African countries, where it states that lifestyle, sociocultural and economic changes are less likely to trigger an increase of blood pressure.
The report said: “Exposure to malaria, particularly repeated episodes of malaria and severe malaria in childhood, has been reported to be a risk factor contributing to the development of hypertension and other cardiovascular diseases.
“The risk factor profile could be the case in some African and Indian populations where malaria has been endemic for many decades.”
Research is still limited
The magazine, however, cautions against taking a conclusive opinion on the matter, saying that the relationship between malaria exposure and cardiovascular diseases such as high blood pressure is still limited.
He said the impact of malaria exposure on cardiovascular health was assessed through “indirectly modulated evolutionary selection in malaria-endemic areas.”
The report noted that one of the direct effects found was the prolonged elevation of pro-inflammatory cytokines, “which harm cardiovascular health and cause cardiovascular diseases.”
Proinflammatory cytokines are small proteins that are released by the body’s cells to initiate and promote inflammation. They help the immune system respond to infections or injuries by causing redness, swelling, heat and pain.
Although pro-inflammatory cytokines are useful for the human body, a prolonged elevation causes inflammation-promoting proteins to remain at high levels for a long time. This, when it occurs, can damage the heart and blood vessels, increasing the risk of cardiovascular diseases such as heart attacks and strokes.
In addition to the risk of prolonged elevation of proinflammatory cytokines, the report found that malaria exposure also has an indirect effect on genetic selection that causes “specific mutations in the two critical enzymes (ACE2 rs4646994 mutation and ACE2 rs2106809 mutation) of human renin. -angiotensin system”.
The report says that certain small changes in two important enzymes in the body, ACE and ACE2, which control blood pressure, can help protect children from becoming seriously ill with malaria. These changes protect children from severe malaria by increasing angiotensin II levels.
However, having higher levels of angiotensin II for a long time could lead to high blood pressure (hypertension) when these children grow up.
“This protection, which is thought to be due to the resulting elevated plasma angiotensin II concentrations, has been hypothesized to predispose individuals to hypertension in adulthood.
“This hypothesis has only been evaluated in hospitalized patients with severe malaria,” the report says.
recommendations
Given the recent discovery of malaria’s impact on cardiovascular health, researchers have called for more research into infectious diseases as risk factors for high blood pressure and other cardiovascular diseases.
The Lancet research recommended that identifying the impact of infectious diseases on CVD may be useful for people in sub-Saharan Africa and Southeast Asia.
The study called for funding to be provided for robust population-wide research to determine the direct and indirect role of malaria exposure in predisposing people to hypertension.
Such research, the study noted, should focus primarily on malaria-endemic areas.
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The report said: “Many biological, sociocultural, economic, environmental and nutritional risk factors have been examined and traditionally attributed to this increasing rise in hypertension. However, infectious diseases, such as malaria, have not been sufficiently investigated as risk factors for high blood pressure and other cardiovascular diseases.
“This research would also help delve deeper into the causes of the pathogenesis of many non-communicable diseases that could be due, at least in part, to various communicable diseases, particularly in low- and middle-income countries.”