Association of hypertension with infection and inflammation in a setting of disadvantage in rural India

Doreen Busingye, Roger G. Evans, Simin Arabshahi, Michaela A. Riddell, Velandai K. Srikanth, Kamakshi Kartik, Kartik Kalyanram, Xuan Zhu, Oduru Suresh, Amanda G. Thrift

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We assessed the association of hypertension with markers of inflammation and infection in a rural and disadvantaged Indian population. In a case–control study, we age- and gender-matched 300 cases with hypertension to 300 controls without hypertension. Blood pressure was measured according to a strict protocol. We measured markers of inflammation and infection including serum high-sensitivity C-reactive protein (hs-CRP), blood lymphocyte count, serum homocysteine, tooth loss, overcrowding and exposure to fecal contamination. Multivariable conditional logistic regression was used to determine their association with hypertension. Median serum hs-CRP was 42% greater in cases than controls, while median serum homocysteine was 10% greater. In multivariable conditional logistic regression, elevated homocysteine (OR 1.75, 95% CI 1.09–2.82), greater lymphocyte count (OR 1.49, 95% CI 1.01–2.01) and exposure to fecal contamination, defined as a distance from the field used for toilet purposes to the household of ≤50 m (OR 2.38, 95% CI 1.07–5.29), were independently associated with hypertension in this rural population. In separate analyses for each gender, elevated hs-CRP (OR 2.62, 95% CI 1.04–6.58) was associated with hypertension in men, whereas edentulism (OR 4.75, 95% CI 1.62–13.96) was associated with greater odds of hypertension in women. Our findings demonstrate specific associations between hypertension and markers of inflammation and infection including hs-CRP, homocysteine, lymphocyte count, edentulism and exposure to fecal contamination. Thus, strategies aimed at reducing inflammation and infection may reduce the burden of hypertension in such settings of disadvantage in rural India.

Original languageEnglish
Pages (from-to)1011–1020
Number of pages10
JournalJournal of Human Hypertension
Issue number11
Publication statusPublished - Nov 2022

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