The High Blood Pressure-Malaria Protection Hypothesis

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Abstract

Rationale:

A recently proposed hypothesis states that malaria may contribute to hypertension in endemic areas1, but the role of angiotensin (Ang) II, a major regulator of blood pressure, was not considered. Elevated levels of Ang II may confer protection against malaria morbidity and/or mortality, providing an alternative explanation for hypertension in malaria endemic areas.

Objective:

To discuss a possible alternative cause for hypertension in populations that have been under the selective pressure of malaria.

Methods and Results:

We reviewed published scientific literature for studies that could establish a link between Ang II and malaria. Both, genetic and functional studies suggested that high levels of Ang II may confer protection against cerebral malaria by strengthening the integrity of the endothelial brain barrier. We also describe strong experimental evidence supporting our hypothesis through genetic, functional and interventional studies.

Conclusions:

A causal association between high levels of Ang II and protection from malaria pathogenesis can provide a likely explanation for the increased prevalence in hypertension observed in populations of African and South Asian origin. Furthermore, this potential causative connection might also direct unique approaches for the effective treatment of cerebral malaria.

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