Does Malaria Cause Hypertension?
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Is malaria a potential cause of hypertension? In this issue of the Circulation Research, Etyang et al1 offer a concise review of the epidemiological data and pathogenetic mechanisms that, according to the current status of knowledge, are thought to link Plasmodium infection to the growing burden of hypertension in the sub-Saharan Africa, some part of Asia and other low-income countries.1,2 They also suggest some research approaches to further explore this emerging issue.1
Article, see p 36
Malaria, a devastating disease that is currently widespread in the tropics, is caused by at least 10 species, pathogen for humans, of the genus Plasmodium, large parasitic protozoa first described in 1885. The infection begins with inoculation of parasite sporozoite by infected mosquitos. The sporozoites rapidly enter the hepatocytes (hepatic stage). In a few days, each sporozoite generates ≈40 000 merozoites per each infected liver cell. The sporozoites of some Plasmodium species may generate hypnozoites, which may remain silent in the hepatocyte for months or years before generating merozoites. The blood stage of malaria starts when merozoites generated in the hepatocytes invade red blood cells (RBCs) and digest hemoglobin. Here, some derivative products of hemoglobin, including hematin, are lethal for the parasite. However, the parasite may convert hematin into the less toxic hemozoin, and this reaction is inhibited by chloroquine. The artemisinins, antimalarial drugs developed from the Chinese herbal remedy qinghaosu, are activated by intraparasitic heme iron, which catalyzes the cleavage of an endoperoxide bridge present in the drug, with resulting production of free radical intermediates that may kill the parasite by alkylating and poisoning essential malarial proteins. …