Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia.
Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, VIC, Australia.
J Hum Hypertens. 2022 Nov;36(11):1011-1020. doi: 10.1038/s41371-021-00609-1. Epub 2021 Sep 17.
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.
我们评估了高血压与炎症和感染标志物在农村和贫困印度人群中的相关性。在一项病例对照研究中，我们按年龄和性别匹配了 300 例高血压患者和 300 例无高血压患者。根据严格的方案测量血压。我们测量了炎症和感染标志物，包括血清高敏 C 反应蛋白（hs-CRP）、血淋巴细胞计数、血清同型半胱氨酸、牙齿缺失、拥挤和粪便污染暴露。采用多变量条件逻辑回归确定它们与高血压的关系。病例组的中位血清 hs-CRP 比对照组高 42%，而中位血清同型半胱氨酸高 10%。在多变量条件逻辑回归中，升高的同型半胱氨酸（OR 1.75，95%CI 1.09-2.82）、较高的淋巴细胞计数（OR 1.49，95%CI 1.01-2.01）和粪便污染暴露，定义为从用于厕所的田地到家庭的距离≤50 m（OR 2.38，95%CI 1.07-5.29），与该农村人群的高血压独立相关。在针对每个性别进行的单独分析中，hs-CRP 升高（OR 2.62，95%CI 1.04-6.58）与男性高血压相关，而缺牙（OR 4.75，95%CI 1.62-13.96）与女性高血压的几率增加相关。我们的研究结果表明，高血压与炎症和感染标志物（包括 hs-CRP、同型半胱氨酸、淋巴细胞计数、缺牙和粪便污染暴露）之间存在特定关联。因此，旨在减少炎症和感染的策略可能会降低印度农村贫困地区高血压的负担。
