{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T20:00:13Z","timestamp":1777406413428,"version":"3.51.4"},"reference-count":43,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2019,3,19]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Malaria exposure in childhood may contribute to high blood pressure (\n              <jats:styled-content style=\"fixed-case\">BP<\/jats:styled-content>\n              ) in adults. We used sickle cell trait (\n              <jats:styled-content style=\"fixed-case\">SCT<\/jats:styled-content>\n              ) and \u03b1\n              <jats:sup>+<\/jats:sup>\n              thalassemia, genetic variants conferring partial protection against malaria, as tools to test this hypothesis.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Study sites were Kilifi, Kenya, which has malaria transmission, and Nairobi, Kenya, and Jackson, Mississippi, where there is no malaria transmission. The primary outcome was 24\u2010hour systolic BP. Prevalent hypertension, diagnosed using European Society of Hypertension thresholds was a secondary outcome. We performed regression analyses adjusting for age, sex, and estimated glomerular filtration rate. We studied 1127 participants in Kilifi, 516 in Nairobi, and 651 in Jackson.\n              <jats:styled-content style=\"fixed-case\">SCT<\/jats:styled-content>\n              frequency was 21% in Kilifi, 16% in Nairobi, and 9% in Jackson.\n              <jats:styled-content style=\"fixed-case\">SCT<\/jats:styled-content>\n              was associated with \u22122.4 (95%\n              <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n              , \u22124.7 to \u22120.2) mm\u00a0Hg lower 24\u2010hour systolic BP in Kilifi but had no effect in Nairobi\/Jackson. The effect of\n              <jats:styled-content style=\"fixed-case\">SCT<\/jats:styled-content>\n              in Kilifi was limited to 30\u2010 to 59\u2010year\u2010old participants, among whom it was associated with \u22126.1\u00a0mm\u00a0Hg (\n              <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n              , \u221210.5 to \u22121.8) lower 24\u2010hour systolic BP. In pooled analysis allowing interaction by site, the effect of\n              <jats:styled-content style=\"fixed-case\">SCT<\/jats:styled-content>\n              on 24\u2010hour systolic BP in Kilifi was \u22123.5\u00a0mm\u00a0Hg (\n              <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n              , \u22126.9 to \u22120.1), increasing to \u22125.2\u00a0mm\u00a0Hg (\n              <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n              , \u22129.5 to \u22120.9) when replacing estimated glomerular filtration rate with urine albumin to creatinine ratio as a covariate. In Kilifi, the prevalence ratio for hypertension was 0.86 (\n              <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n              , 0.76\u20130.98) for\n              <jats:styled-content style=\"fixed-case\">SCT<\/jats:styled-content>\n              and 0.89 (\n              <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n              , 0.80\u20130.99) for \u03b1\n              <jats:sup>+<\/jats:sup>\n              thalassemia.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Lifelong malaria protection is associated with lower\n              <jats:styled-content style=\"fixed-case\">BP<\/jats:styled-content>\n              in Kilifi. Confirmation of this finding at other sites and elucidating the mechanisms involved may yield new preventive and therapeutic targets.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.118.011771","type":"journal-article","created":{"date-parts":[[2019,3,16]],"date-time":"2019-03-16T09:00:21Z","timestamp":1552726821000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":22,"title":["Effect of Previous Exposure to Malaria on Blood Pressure in Kilifi, Kenya: A Mendelian Randomization Study"],"prefix":"10.1161","volume":"8","author":[{"given":"Anthony O.","family":"Etyang","sequence":"first","affiliation":[{"name":"KEMRI\u2010Wellcome Trust Research Programme Kilifi Kenya"},{"name":"London School of Hygiene and Tropical Medicine London United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sailoki","family":"Kapesa","sequence":"additional","affiliation":[{"name":"KEMRI\u2010Wellcome Trust Research Programme Kilifi Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily","family":"Odipo","sequence":"additional","affiliation":[{"name":"KEMRI\u2010Wellcome Trust Research Programme Kilifi Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Evasius","family":"Bauni","sequence":"additional","affiliation":[{"name":"KEMRI\u2010Wellcome Trust Research Programme Kilifi Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catherine","family":"Kyobutungi","sequence":"additional","affiliation":[{"name":"African Population and Health Research Centre Nairobi Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marwah","family":"Abdalla","sequence":"additional","affiliation":[{"name":"Columbia University Medical Center New York NY"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Muntner","sequence":"additional","affiliation":[{"name":"University of Alabama at Birmingham AL"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Solomon K.","family":"Musani","sequence":"additional","affiliation":[{"name":"University of Mississippi Medical Center Jackson MS"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alex","family":"Macharia","sequence":"additional","affiliation":[{"name":"KEMRI\u2010Wellcome Trust Research Programme Kilifi Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas N.","family":"Williams","sequence":"additional","affiliation":[{"name":"KEMRI\u2010Wellcome Trust Research Programme Kilifi Kenya"},{"name":"Imperial College London United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J. 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