title: Association of pathogen burden and hypertension: the Persian Gulf Healthy Heart Study.
abstract: BACKGROUND
  Chronic infection with cytomegalovirus (CMV), Chlamydia pneumoniae, herpes simplex virus 1 (HSV-1), and Helicobacter pylori may contribute to essential hypertension. However, the evidence now available does not clarify whether the aggregate number of pathogens (pathogen burden) may be associated with hypertension.
  
  
  METHODS
  Sera from 1,754 men and women aged ≥25 years were analyzed for immunoglobulin G antibodies to C. pneumoniae, HSV-1, H. pylori, and CMV using enzyme-linked immunosorbent assay. The aggregate number of seropositives to the studied viral and bacterial agents was defined as pathogen burden. Hypertension was defined according to World Health Organization criteria.
  
  
  RESULTS
  A total of 459 (26.3%) of the subjects had hypertension. In the hypertensive group, 4.2% had 0 or 1 pathogens present, 20.6% had 2, 43.2% had 3, and 32.1% had 4; in the normotensive group, 7.9% had 0 or 1, 28.4% had 2, 42.7% had 3, and 21.0% had 4. Of the 4 studied pathogens, H. pylori seropositivity showed a significant independent association with hypertension (odds ratio (OR) =1.37; 95% confidence interval (CI) =1.05-1.79; P = 0.02). In multiple logistic regression analyses, the pathogen burden did not show a significant independent association with hypertension. Coinfection with H. pylori and C. pneumoniae was significantly associated with hypertension compared with double seronegativity after adjustment for age, sex, chronic low-grade inflammation, and cardiovascular risk factors (OR = 1.68; 95% CI = 1.14-2.47; P = 0.008].
  
  
  CONCLUSIONS
  The pathogen burden was not associated with hypertension. However, coinfection with C. pneumoniae and H. pylori showed a significant association with essential hypertension, independent of cardiovascular risk factors and chronic low-grade inflammation.
authors.affiliation: Department of Infectious Diseases, Persian Gulf Tropical Medicine Research Centre, Bushehr University of Medical Sciences, Bushehr, Iran.
authors.forename: Katayoun
authors.initials: K
authors.lastname: Vahdat
authors.forename: Mohammad Reza
authors.initials: MR
authors.lastname: Pourbehi
authors.forename: Afshin
authors.initials: A
authors.lastname: Ostovar
authors.forename: Fahimeh
authors.initials: F
authors.lastname: Hadavand
authors.forename: Alireza
authors.initials: A
authors.lastname: Bolkheir
authors.forename: Majid
authors.initials: M
authors.lastname: Assadi
authors.forename: Maryam
authors.initials: M
authors.lastname: Farrokhnia
authors.forename: Iraj
authors.initials: I
authors.lastname: Nabipour
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology; D023521:Chlamydophila Infections / Q000150:complications / Q000276:immunology; D016993:Chlamydophila pneumoniae / Q000276:immunology; D002908:Chronic Disease; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003587:Cytomegalovirus / Q000276:immunology; D000075222:Essential Hypertension; D005260:Female; D016481:Helicobacter Infections / Q000150:complications / Q000276:immunology; D016480:Helicobacter pylori / Q000276:immunology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000382:microbiology*; D007074:Immunoglobulin G / Q000097:blood; D007492:Iran / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D019562:Viral Load
chemical_list: D007074:Immunoglobulin G
keywords: Chlamydia pneumoniae; Helicobacter pylori; blood pressure; cytomegalovirus; herpes simplex virus; hypertension; pathogen.