title: The Malaria-High Blood Pressure Hypothesis.
abstract: BACKGROUND
  Several studies have demonstrated links between infectious diseases and cardiovascular conditions. Malaria and hypertension are widespread in many low- and middle-income countries, but the possible link between them has not been considered.
  
  
  OBJECTIVE
  In this article, we outline the basis for a possible link between malaria and hypertension and discuss how the hypothesis could be confirmed or refuted.
  
  
  RESULTS
  We reviewed published literature on factors associated with hypertension and checked whether any of these were also associated with malaria. We then considered various study designs that could be used to test the hypothesis. Malaria causes low birth weight, malnutrition, and inflammation, all of which are associated with hypertension in high-income countries. The hypothetical link between malaria and hypertension can be tested through the use of ecological, cohort, or Mendelian randomization studies, each of which poses specific challenges.
  
  
  CONCLUSIONS
  Confirmation of the existence of a causative link with malaria would be a paradigm shift in efforts to prevent and control hypertension and would stimulate wider research on the links between infectious and noncommunicable disease.
authors.affiliation: From the Department of Epidemiology and Demography, KEMRI-Wellcome Trust Research Program, Kilifi, Kenya (A.O.E., J.A.G.S.); Department of Infectious Disease Epidemiology (A.O.E., J.A.G.S.), and Department of Non-Communicable Disease Epidemiology (L.S.), London School of Hygiene and Tropical Medicine, London, United Kingdom; and Cardiovascular Medicine Group, Division of Diabetes and Nutritional Sciences, King's College, London, United Kingdom (J.K.C.). aetyang@kemri-wellcome.org.
authors.forename: Anthony O
authors.initials: AO
authors.lastname: Etyang
authors.affiliation: From the Department of Epidemiology and Demography, KEMRI-Wellcome Trust Research Program, Kilifi, Kenya (A.O.E., J.A.G.S.); Department of Infectious Disease Epidemiology (A.O.E., J.A.G.S.), and Department of Non-Communicable Disease Epidemiology (L.S.), London School of Hygiene and Tropical Medicine, London, United Kingdom; and Cardiovascular Medicine Group, Division of Diabetes and Nutritional Sciences, King's College, London, United Kingdom (J.K.C.).
authors.forename: Liam
authors.initials: L
authors.lastname: Smeeth
authors.affiliation: From the Department of Epidemiology and Demography, KEMRI-Wellcome Trust Research Program, Kilifi, Kenya (A.O.E., J.A.G.S.); Department of Infectious Disease Epidemiology (A.O.E., J.A.G.S.), and Department of Non-Communicable Disease Epidemiology (L.S.), London School of Hygiene and Tropical Medicine, London, United Kingdom; and Cardiovascular Medicine Group, Division of Diabetes and Nutritional Sciences, King's College, London, United Kingdom (J.K.C.).
authors.forename: J Kennedy
authors.initials: JK
authors.lastname: Cruickshank
authors.affiliation: From the Department of Epidemiology and Demography, KEMRI-Wellcome Trust Research Program, Kilifi, Kenya (A.O.E., J.A.G.S.); Department of Infectious Disease Epidemiology (A.O.E., J.A.G.S.), and Department of Non-Communicable Disease Epidemiology (L.S.), London School of Hygiene and Tropical Medicine, London, United Kingdom; and Cardiovascular Medicine Group, Division of Diabetes and Nutritional Sciences, King's College, London, United Kingdom (J.K.C.).
authors.forename: J Anthony G
authors.initials: JA
authors.lastname: Scott
mesh_terms: D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D008288:Malaria / Q000453:epidemiology*
keywords: arterial stiffness; blood pressure; epidemiology; inflammation; malaria