Helicobacter pylori and hypertension: a cross-sectional study based on a healthy population

doi:10.21203/rs.3.rs-2634360/v1

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Helicobacter pylori and hypertension: a cross-sectional study based on a healthy population

https://doi.org/10.21203/rs.3.rs-2634360/v1

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In this study, we aimed to clarify whether H. pylori infection is associated with the prevalence of hypertension in the Inner Mongolia crowds and whether gender and age affect the relationship between helicobacter pylori and hypertension. We collected physical examination data from 10,517 people in the Second Affiliated Hospital of Baotou Medical College from January to December in 2020. The study population was divided into three layers according to blood pressure and H. pylori infection status. We found the patients that infected with H. pylori were associated with blood pressure. And the infection rate of H. pylori in patients with hypertension is higher than that in non-hypertensive individuals. Otherwise, Gender and age influence the relationship between helicobacter pylori and hypertension. In the hypertensive population, H. pylori infection rates are higher in males than in females. In additional, the hypertensive with H. pylori-infected population, the degree of H. pylori infection was lower in young adults than in middle-aged adultsand the elderly.People with established hypertension, men are more likely to be infected with H. pylori and to have more severe infections. In contrast, the degree of H. pylori infection is lower in young peoplethan in other people in people with hypertension and infected with H. pylori.

Health sciences/Diseases/Cardiovascular diseases/Hypertension

Health sciences/Medical research

Hypertension

H. pylori

Sex&Age

across-sectional

Hypertension is one of the most prevalent diseases of the cardiovascular system, which has higher fatality rate. But somehow, the detailed pathophysiological mechanism of hypertension is still unclear. Among many influencing agents, the influence of inflammation on hypertension has become very popular in recent years. The immune response due to inflammation not only affects the formation of hypertension but also can increase the risk of other cardiovascular diseases such as stroke and heart failure on top of hypertensive disease^[1]. Currently, the prevalence of hypertension in China has reached 23%^[2]. So to study the detail mechanisms of hypertension is necessary.

H. pylori is a microaerobic gram-negative bacteria that resides in the stomach and is transmitted through the fecal-oral route. The prevalence of H. pylori infection in the Chinese population is at a high level in the world and higher than the average of Asians (55.8% vs. 44.7%)^[3–5]. This may be related to the lack of understanding of the risk of H. pylori in China and the Chinese potluck style of diet ^[6]. Many researchers found that inflammatory responses caused by intestinal dysbiosis and H. pylori infection are closely associated with hypertension. Short-chain fatty acids and corticosterone produced by dysbiosis of intestinal flora promote the development of hypertension^[7–9]. Maybe this can be a way to investigate the mechanisms of hypertension.

H. pylori may be associated with sodium retention, vascular endothelial damage, insulin resistance, disorders of lipid metabolism, and altered intestinal flora, and these alterations possibly affect the elevation of blood pressure and the severity of hypertension^[10–14]. A cross-sectional study by wang et al. found a positive association between the prevalence of H. pylori infection and hypertension^[15]. Xiong et al.had and that H. pylori infection not only affects the incidence of hypertension, but also the infection rate of H. pylori in patients with hypertension is higher than that in people with normal blood pressure^[16]. Therefore, we investigated the association between hypertension and H. pylori by collecting various indicators from the physically examined population in the Baotou city of Inner Mongolia, China.

2.1 Trial Design and grouping criteria:

We collected from data from 10,517 people who were under the examination Medical in the Second Affiliated Hospital of Baotou Medical College from January 2020 to December 2020(All were informed of the purpose of the study and signed an informed consent form). ¹⁴C breath test and blood pressure measurement were used to patients who were categorized age and disease history. According to blood pressure status, the participants were divided into hypertensive and normotensive. Due to the pylori infection the hypertensive group was divided the into the hypertensive group with H. pylori infection and the hypertensive group without H. pylori infection. The hypertensive population was divided into male and female groups according to gender, and into young, middle-aged, and elderly groups according to the age of the participants (We define the group between 20 years old and 40 years old as young people, 41–65 years old as middle-aged people, and over 66 years old as old people).

2.2 Evaluation of hypertension:

The blood pressure of the physical examinees was measured by an electronic sphygmomanometer (automatic sphygmomanometer HPP-9020). Experiment subjects required without smoking, drinking tea or coffee, or empty their bladder for 30 minutes before their blood pressure measurement. Before examination volunteers sit in a chair in a back and quiet environment for rest larger than 5 minutes to relax the whole body enough. After three measurements, the average value was taken as the test result. Hypertension was defined as systolic blood pressure ≥ 140mmHg and or diastolic blood pressure ≥ 90mmHg.

2.3 Assessment of Helicobacter pylori inion

The measurement of the ¹⁴C breath teas used to detect H. pylori infection in the medical examination population. The subjects were tested on an empty stomach or two hours after eating, and one urea [¹⁴C] capsule was taken orally. After 15 minutes, the test was carried out by blowing and using the H. pylori tester, HUBT-20A. The results were expressed as 20-minute DPM, and the results greater than or equal to 100 were defined as positive for H. pylori infection.

2.4 Covariate measurement:

While performing blood pressure measurements, the age of patients, gender, and past medical history were recorded. The data was recorded and uploaded by the designated professional physician and the corresponding diagnosis was made at the same time. Blood routine examination(white blood cells, red blood cells, neutrophils, etc.) was measured by the automatic blood cell analyzer BC-6800PLUS in the laboratory department of the hospital. Urine sediment analyzer SysmexUF-50 was used to detect urea, uric acid(UA), and creatinine(CREA). Fasting plasma glucose (FPG), triglyceride(TG), total cholesterol(TC), high-density lipoprotein cholesterol(HDL-C), low-density lipoprotein cholesterol(LDL-C), total bilirubin(TBil), direct bilirubin(DBil), alanine aminotransferase(ALT), aspartate aminotransferase(AST), γ -glutamyltransferase(GGT), globulin(GLb) and albumin/globulin ratio(A/G) were detected by automatic biochemical immunoassay CoBAS 8000.

2.5 Data analysis:

All data analyzed were performed using SPSS version 26.0 for statistical analysis. Measurement data of normal distribution were expressed as the means ± standard deviation (x ̅ ± s), and a t-test was used for comparison between the two groups. Numeral data were expressed as percentages and analyzed by the chi-square test.

Informed consent for all participation in the study has been obtained. ethical approval were obtained for the study. (Approved by the Ethics Committee of the Second Affiliated Hospital of Baotou Medical College LW-014).

3.1 Comparison of various clinical indicators between hypertensive and non-hypertensive populations in Inner Mongolia(Fig. 1).

A total of 10,517 physical examination subjects were included in this study, including 3,335 hypertension patients, accounting for 33.3% of the population examined. The number of people infected with H. pylori was 2815, which was 28.1% of the total population.

Removing the information from the population that did not complete all examinations, the remaining 9363 cases. There were 3,015 people with hypertension, and 2599 people were infected with H. pylori. The screened population was grouped according to whether they had hypertension or not, and after excluding those with white coat hypertension, the hypertensive population totaled 2044. These 2044 hypertensive patients were used as the hypertensive group, and 2044 normotensive people(no other diseases) were randomly selected as the control group using SPSS. We used SPSS to analyze the differences in the clinical index between the two groups.

The group was divided into groups based on whether there was hypertension or not, and the differences between the indicators of the examined population were analyzed. And it was concluded that there were significant differences between the hypertensive and normotensive population in terms of age, sex, urea, uric acid (UA), creatinine (CREA), urine protein, fasting blood glucose (FPG), triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total bilirubin (TBil), direct bilirubin (DBil), indirect bilirubin (IBil), alanine aminotransferase (ALT), γ-glutamyltransferase (GGT), globulin (GLB), white blood cell (WBC), red blood cell (RBC), hemoglobin(Hb) platelets(PLT), lymphocyte, neutrophil, monocyte and the infection rate of H. pylori. (see Table 1). The infection rate of H. pylori in the hypertensive group was higher than that in the normal blood pressure group(29.16%vs25.44%,p < 0.05).

Table 1

Characteristics of subjects grouped according to blood pressure
variable	no Hypertension n = 2044	Hypertension n = 2044	t/χ²	p-value
age(y)	44.93 ± 12.71	52.52 ± 13.27	-18.675	< 0.001
Sex(female)	928(45.40%)	721(35.27%)	43.553	< 0.001
Renal function test
Urea(mmol/L)	4.66 ± 1.20	4.80 ± 1.20	-3.633	< 0.001
Crea (µmol/L)	73.05 ± 13.93	74.75 ± 14.65	-3.807	< 0.001
Uric acid(µmol/L)	335.56 ± 92.47	360.50 ± 92.75	-8.612	< 0.001
urine protein	86(4.21%)	203(9.93%)	50.970	< 0.001
FPG (mmol/L)	5.22 ± 1.08	5.64 ± 1.36	-10.897	< 0.001
Blood lipid test
TG (mmol/L)	1.56 ± 1.01	1.99 ± 1.26	-11.789	< 0.001
TC (mmol/L)	4.70 ± 0.91	4.95 ± 0.94	-8.668	< 0.001
HDL-C (mmol/L)	1.26 ± 0.28	1.23 ± 0.28	3.537	< 0.001
LDL-C (mmol/L)	2.92 ± 0.79	3.08 ± 0.78	-6.821	< 0.001
TBil (µmol/L)	14.18 ± 6.07	14.69 ± 5.98	-2.744	0.006
Dbil (µmol/L)	2.02 ± 1.25	2.11 ± 1.16	-2.466	0.014
IBil (µmol/L)	12.15 ± 5.35	12.58 ± 5.30	-2.579	0.010
Liver function test
ALT (U/L)	22.56 ± 16.81	26.71 ± 21.77	-6.831	< 0.001
GGT (U/L)	28.71 ± 30.17	39.77 ± 39.51	-10.062	< 0.001
TP(g/L)	75.90 ± 22.19	76.37 ± 21.86	-0.679	0.497
ALB(g/L)	47.33 ± 13.63	46.81 ± 3.23	1.683	0.092
GLB(g/L)	28.27 ± 3.42	28.84 ± 3.67	-5.111	< 0.001
A/G	1.74 ± 1.38	1.73 ± 1.76	0.117	0.907
Blood routine examination
WBC (×10⁹/L)	5.95 ± 1.51	6.30 ± 1.59	-7.129	< 0.001
RBC(×10⁹/L)	4.96 ± 0.44	5.06 ± 0.47	-6.524	< 0.001
Hb(g/L)	155.33 ± 17.31	160.42 ± 18.86	-8.999	< 0.001
PLT(×10⁹/L)	245.01 ± 56.27	240.35 ± 59.27	2.578	0.010
lymphocyte(×10⁹/L)	2.00 ± 0.55	2.09 ± 0.60	-4.855	< 0.001
neutrophil(×10⁹/L)	3.46 ± 1.15	3.71 ± 1.26	-6.521	< 0.001
monocyte(×10⁹/L)	0.33 ± 1.10	0.35 ± 0.13	-5.309	< 0.001
EOS(×10⁹/L)	0.14 ± 0.11	0.14 ± 0.12	-1.093	0.275
B(×109/L)	0.03 ± 0.02	0.03 ± 0.02	-1.923	0.055
hp	520(25.44%)	596(29.16%)	7.119	0.008

Note: Crea:Creatinine; FPG:fasting blood-glucose; TG:triglyceride; TC:total cholesterol; HDL-C:high-density lipoprotein cholesterol; LDL-C:low-density lipoprotein cholesterol; TBil:total bilirubin; Dbil:direct bilirubin; IBil:indirect bilirubin; GGT:γ-glutamyltransferase; ALT: alanine aminotransferase; TP:total protein; ALB:albumin; GLB:globulin; A/G:ratio of albumin to globulin; WBC:white blood cell; RBC:red blood cell; Hb:hemoglobin; PLT:platelet; EOS:eosinophilic granulocyte; B:basophilic granulothere ishelicodifferencesori

Legethereise some difference bedifferencesrtensive people and the Normotensive people in the prevmeane of H. pylori infection,m ,ean age, gender composition,n and other clinical indicators.

3.2.1 Differences in the prevalence of Helicobacter pylori infection between men and women in a hypertensive population

The hypertension group was divided by sex, including 721 females and 1323 males. 721 women were selected as a group and 721 men were randomly selected as a group out of 1,323 men. After analysis with SPSS, there was no statistical difference between the two groups only in the level of hypertension and A/G. A total of 188 of the female hypertensive patient population were infected wH. pylori, and there were 224 the male hypertensive patients infected with H. pylori. The prevalence of H. pylori infection was higher in male hypertensive patients than in female hypertensive patients(31.07%vs26.07%,p = 0.036). ( Fig. 2)

3.2.2 Differences in clinical indicators between men and women in a population with hypertension co-infected with Helicobacter pylori

Patients with hypertension combined with H. pylori were 596 people. They were grouped according to gender. There were 188 females and 188 males (simple random sampling from 408 cases using spss) Statistical analysis showed that there was a difference in DBP, Urea, Crea, Uric acid, urine protein, FPG, TC, HDL-C, TBil, Dbil, IBil, GGT, ALB, GLB, A/G, WBC, RBC, Hb, PLT, neutrophil, monocyte, EOS, and H. pylori infection rate between the two groups( Table 2, Fig. 3).

Table 2

Characteristics between males and females in hypertensive combined with H. pylori populations
variable	Female n = 188	Male n = 188	t/χ²	p-value
age(y)	54.39 ± 11.62	52.99 ± 14.21	1.041	0.298
Blood pressure
Level of hypertension	127(67.55%)	122(64.89%)	3.924	0.141
SBP(mmHg)	151.80 ± 12.85	152.74 ± 13.95	-0.677	0.499
DBP(mmHg)	88.14 ± 11.21	92.78 ± 10.60	-4.128	< 0.001
Renal function test
Urea(mmol/L)	4.58 ± 1.14	5.09 ± 1.24	-4.161	< 0.001
Crea (µmol/L)	64.27 ± 10.72	81.47 ± 12.76	-14.150	< 0.001
Uric acid(µmol/L)	316.31 ± 87.48	380.95 ± 88.65	-7.115	< 0.001
urine protein	9(4.79%)	22(11.70%)	5.941	0.023
FPG (mmol/L)	5.53 ± 1.10	5.87 ± 1.69	-2.307	0.022
Blood lipid test
TG (mmol/L)	1.81 ± 1.07	2.00 ± 1.32	-1.514	0.131
TC (mmol/L)	5.15 ± 0.92	4.91 ± 0.91	2.527	0.012
HDL-C (mmol/L)	1.33 ± 0.28	1.19 ± 0.25	5.040	< 0.001
LDL-C (mmol/L)	3.18 ± 0.78	3.04 ± 0.74	1.830	0.068
TBil (µmol/L)	12.56 ± 4.54	15.20 ± 6.08	-4.788	< 0.001
Dbil (µmol/L)	1.61 ± 0.68	2.37 ± 0.98	-8.778	< 0.001
IBil (µmol/L)	10.92 ± 4.19	12.83 ± 5.42	-3.810	< 0.001
Liver function test
ALT (U/L)	25.13 ± 23.53	27.94 ± 22.06	-1.192	< 0.234
GGT (U/L)	30.74 ± 37.38	46.73 ± 41.85	-3.907	< 0.001
TP(g/L)	80.41 ± 51.37	75.15 ± 4.09	1.402	0.163
ALB(g/L)	46.12 ± 3.87	47.19 ± 2.85	-3.043	0.003
GLB(g/L)	30.58 ± 3.73	27.95 ± 3.46	7.069	< 0.001
A/G	1.53 ± 0.21	1.80 ± 1.21	-3.037	0.003
Blood routine examination
WBC (×10⁹/L)	6.22 ± 1.68	6.66 ± 1.57	-2.569	0.011
RBC(×10⁹/L)	4.76 ± 0.33	5.17 ± 0.43	-10.596	< 0.001
Hb(g/L)	146.58 ± 13.36	167.19 ± 11.33	-16.134	< 0.001
PLT(×10⁹/L)	259.55 ± 60.03	224.03 ± 59.68	5.753	< 0.001
lymphocyte(×10⁹/L)	2.11 ± 0.61	2.14 ± 0.62	-0.535	0.593
neutrophil(×10⁹/L)	3.65 ± 1.30	3.95 ± 1.18	-2.319	0.021
monocyte(×10⁹/L)	0.32 ± 0.15	0.37 ± 0.11	-3.675	< 0.001
EOS(×10⁹/L)	0.12 ± 0.14	0.15 ± 0.12	-2.409	0.016
B(×109/L)	0.03 ± 0.01	0.03 ± 0.02	-0.948	0.344
hp	1(31.38%)	1(48.40%)	16.660	< 0.001
Note: Crea:Creatinine; FPG:fasting blood-glucose; TG:triglyceride; TC:total cholesterol; HDL-C:high-density lipoprotein cholesterol; LDL-C:low-density lipoprotein cholesterol; TBil:total bilirubin; Dbil:direct bilirubin; IBil:indirect bilirubin; GGT:γ-glutamyltransferase; ALT: alanine aminotransferase; TP:total protein; ALB:albumin; GLB:globulin; A/G:ratio of albumin to globulin; WBC:white blood cell; RBC:red blood cell; Hb:hemoglobin; PLT:platelet; EOS:eosinophilic granulocyte; B:basophilic granulocyte Hp:helicobacter pylori

Legend: Differences in DBP, Urea, Crea, Uric acid, urine protein, FPG, TC, HDL-C, TBil, Dbil, IBil, GGT, ALB, GLB, A/G, WBC, RBC, Hb, PLT, neutrophil, monocyte, EOS, and H. pylori infection rates in males and females with co-infected H. pylori hypertension.

3.3 Effect of age on the relationship between Helicobacter pylori and hypertension

3.3.1 Variation in H.pylori infection rates among young, middle-aged, and elderly people with hypertension.

The hypertension group was divided into the young group, the middle-aged group, and the old group according to age. There were 372 people in the youth group, 1330 people in the middle age group, and 342 people in the elderly group. We randomly selected 342 people from each group as the final study subjects. Statistical analysis by SPSS found that among these study subjects, 100 young people, 98 middle-aged people, and 109 elderly people were infected with H. pylori, accounting for 29.24%, 28.65%, and 31.87% of the population in each group, respectively. But there was no statistical difference in the helicobacter pylori infection rate. (see Fig. 4)

3.3.2 Clinical indicators in young, middle-aged, and elderly people with co-infection with H. pylori in the hypertensive population

According to the above age grouping method, the population was divided into three categories: young, middle-aged, and old. Among them, 110 were young people, 377 were middle-aged people and 109 were old people. After exclusion of other diseases,109 were randomly selected from the young, middle-aged, and old people respectively as the youth group, middle-age group, and old people group. After statistical analysis, three groups were different in SBP, DBP, Urea, Uric acid, TG, ALT, GGT, ALB, GLB, A/G, WBC, RBC, Hb, PLT, lymphocyte, neutrophil, monocyte, basophilic granulocyte. The degree of Helicobacter pylori infection was different. (see Table 3) Urea, ALT, ALB, RBC, Hb, PLT Among them, the expression levels of Urea, ALT, ALB, RBC, Hb, PLT were different in the comparison between young and middle-aged, middle-aged and old, and young and middle-aged (p < 005). The differences in the expression levels of SBP, DBP, GGT, GLB, and A/G were mainly found between young and old, and between middle-aged and old (p < 005). Uric acid, TG, WBC, lymphocyte, neutrophil, and basophilic granulocyte expression levels were significantly different in the young versus middle-aged and young versus old (p < 0.05). The discrepancy in monocyte levels was only present in youth versus middle age (p = 0.009). In terms of H. pylori test results, the level of infection was lower in the young population than in the middle-aged population (196.39 ± 91.34 vs 239.49 ± 125.16, p = 0.004), and also below the level of infection in the young group compared to the old group(196.39 ± 91.34 vs 273.84 ± 157.93, p < 0.001).

Table 3

Description of the characteristics of people of different ages with hypertension combined with H. pylori
variable	20–40 n = 109	41–65 n = 109	66–99 n = 109	F/χ²	p-value
Sex(female)	21(19.27%)	36(35.78%)	33(30.28%)	5.795	0.055
Blood pressure
Level of hypertension	75(68.81%)	75(68.81%)	63(57.80%)	4.282	0.369
SBP(mmHg)	147.82 ± 11.22	149.12 ± 11.90	157.80 ± 13.43	21.499	< 0.001
DBP(mmHg)	94.21 ± 9.83	92.49 ± 10.10	85.69 ± 11.26	20.410	< 0.001
Renal function test
Urea(mmol/L)	4.55 ± 1.12	4.87 ± 1.21	5.22 ± 1.25	8.775	< 0.001
Crea (µmol/L)	76.95 ± 12.76	75.28 ± 13.38	78.03 ± 16.37	1.024	0.360
Uric acid(µmol/L)	412.20 ± 99.87	353.16 ± 91.46	333.51 ± 72.51	23.245	< 0.001
urine protein	14(12.84%)	15(13.76%)	17(15.60%)	0.354	0.838
FPG (mmol/L)	5.53 ± 1.37	5.66 ± 1.22	5.91 ± 1.48	2.160	0.117
Blood lipid test
TG (mmol/L)	2.44 ± 1.78	1.83 ± 1.23	1.65 ± 0.97	9.805	< 0.001
TC (mmol/L)	4.94 ± 0.90	4.90 ± 0.84	4.91 ± 0.92	0.055	0.946
HDL-C (mmol/L)	1.17 ± 0.29	1.24 ± 0.23	1.25 ± 0.25	2.558	0.079
LDL-C (mmol/L)	3.06 ± 0.75	3.02 ± 0.70	3.18 ± 0.76	1.528	0.218
TBil (µmol/L)	13.99 ± 5.29	14.60 ± 5.69	14.59 ± 6.14	0.406	0.666
Dbil (µmol/L)	2.14 ± 0.77	2.13 ± 0.90	2.25 ± 1.12	0.533	0.588
IBil (µmol/L)	11.85 ± 4.79	12.47 ± 5.01	12.33 ± 5.27	0.455	0.635
Liver function test
ALT (U/L)	44.19 ± 35.80	28.18 ± 21.74	18.38 ± 9.31	30.160	< 0.001
GGT (U/L)	58.20 ± 51.18	45.77 ± 46.82	28.48 ± 20.01	13.982	< 0.001
TP(g/L)	76.90 ± 4.18	75.63 ± 4.35	75.89 ± 3.82	2.900	0.056
ALB(g/L)	48.06 ± 2.55	46.61 ± 3.40	45.60 ± 2.87	18.972	< 0.001
GLB(g/L)	28.84 ± 3.81	28.81 ± 3.84	30.26 ± 3.68	5.245	0.006
A/G	1.82 ± 1.30	1.65 ± 0.25	1.53 ± 0.24	3.832	0.023
Blood routine examination
WBC (×10⁹/L)	7.28 ± 1.98	6.36 ± 1.55	6.32 ± 1.46	11.303	< 0.001
RBC(×10⁹/L)	5.25 ± 0.43	5.05 ± 0.47	4.89 ± 0.44	17.558	< 0.001
Hb(g/L)	165.91 ± 11.25	161.40 ± 14.80	156.90 ± 14.34	12.038	< 0.001
PLT(×10⁹/L)	257.45 ± 58.71	236.15 ± 55.81	213.64 ± 61.48	15.173	< 0.001
lymphocyte(×10⁹/L)	2.43 ± 0.65	2.16 ± 0.62	2.04 ± 0.60	11.369	< 0.001
neutrophil(×10⁹/L)	4.26 ± 1.47	3.69 ± 1.24	3.75 ± 1.14	6.418	0.002
monocyte(×10⁹/L)	0.39 ± 0.12	0.35 ± 0.12	0.36 ± 0.11	3.729	0.025
EOS(×10⁹/L)	0.16 ± 0.11	0.14 ± 0.11	0.13 ± 0.11	1.933	0.146
B(×109/L)	0.04 ± 0.02	0.03 ± 0.02	0.03 ± 0.02	3.122	0.045
hp	196.39 ± 91.34	239.49 ± 125.16	273.84 ± 157.93	10.062	< 0.001
Note: Crea:Creatinine; FPG:fasting blood-glucose; TG:triglyceride; TC:total cholesterol; HDL-C:high-density lipoprotein cholesterol; LDL-C:low-density lipoprotein cholesterol; TBil:total bilirubin; Dbil:direct bilirubin; IBil:indirect bilirubin; GGT:γ-glutamyltransferase; ALT: alanine aminotransferase; TP:total protein; ALB:albumin; GLB:globulin; A/G:ratio of albumin to globulin; WBC:white blood cell; RBC:red blood cell; Hb:hemoglobin; PLT:platelet; EOS:eosinophilic granulocyte; B:basophilic granulocyte Hp:helicobacter pylori

Legend: The three groups differed in terms of SBP, DBP, urea, uric acid, TG, ALT, GGT, ALB, GLB, A/G, WBC, RBC, Hb, PLT, lymphocytes, neutrophils, monocytes, basophils, and the degree of H. pylori infection.

Through this cross-sectional study, we found that there is a certain association between the infection rate of H. pylori and hypertension. People with H. pylori infection had higher SBP, DBP, and a higher prevalence of hypertension than people without H. pylori infection. In addition, The prevalence of H. pylori infection and the degree of H. pylori infection are lower in women than in men; In terms of age, H. pylori infection is also higher in the elderly and middle-aged than in young people.

In this study, overall population incidence of H. pylori infection was 28.1%, which is lower than in other studies. A cross-sectional study of 5246 healthy people which was carried out in Wuhan China has found that the H. pylori infection rate was 32.6%^[14] The prevalence of H. pylori is regional and is strongly associated with the family size, education level, lifestyle habits, and income level of the local population^[18]. Our analysis found that the prevalence of H. pylori infection was higher in the hypertensive population than in the normotensive population(29.16%vs25.44%). This is the same as what Vahdat scholars have found^[19]. However, in early studies on H. pylori and metabolic syndrome, it was found that there was no association between H. pylori and blood pressure. ^[20]. But in the study, their method of judging whether they were infected with H. pylori was serological indicators, and there was a gap in the sensitivity and specificity of the serological tests compared to the (UBT) breath test, which is currently recognized as the gold standard for H. pylori detection ^[21]. There were significant differences in age, and sex between hypertensive and normal blood pressure groups. Data from the National Health and Nutrition Examination Survey show differences in hypertension control by gender and age ^[22]

We also found differences in the prevalence of H. pylori infection between males and females. The rate and the level of H. pylori infection were higher in males than females. Meanwhile, Sun and Chen found that H. pylori infection was a relation to sex^{[23, 24]}. Males and females show variation in intragastric acidity and plasma gastrin concentration profiles, which may influence the H. pylori infection^[25]. Xiong and other investigators found that H. pylori infection was associated with elevated blood pressure^[16]. According to studies, after human infection with H. pylori, the body will appear for a protein involved in cytotoxic immune response, generate an H. pylori antibody, the antibodies will cross-reaction with the antigen on the walls of blood vessels, and release a series of inflammatory factors stimulate blood vessel walls, the influence of microvascular vascular systolic and diastolic, among which the release of IL-8 also activates norepinephrine. Disturbed immune response to H. pylori infection causes vasoconstriction and endothelial dysfunction, which affect the blood pressure of the organism. ^{[26, 27]}. The expression of IL-8 varies between the sexes and is often protective in women but a risk factor in men^[28]. This may be why males had a higher H. pylori infection rate as well as the degree of H. pylori infection was more severe than females. When further analyzing the differences in clinical indicators of different genders in hypertensive patients complicated with H. pylori infection, we found that the HDL-C level of females was higher than that of males. this is due to H. pylori can affect lipid profiles and may vary by gender ^[29].

Among the hypertensive patients complicated with H. pylori infection, age played an important role in the degree of H. pylori infection. The degree of H. pylori infection in young people(< 40 years old) is the lowest compared with middle-aged and old people. Wenjun and other scholars found that people over 40 years of age in China are more likely to develop homocysteinemia ^[30]. H. pylori infection may play a role in this process. H. pylori infection also causes a decrease in the absorption of folic acid and vitamin B12, which increases the level of homocysteine (Hcy). The high level of Hcy entering the blood not only causes damage to the vascular endothelium, stimulating collagen fiber synthesis, smooth muscle cell proliferation, and elastic fiber lysis in the vascular wall, causing vascular remodeling but also inhibits nitric oxide secretion by endothelial cells, causing PLT aggregation and vasoconstriction. Damage to the vascular endothelium causes an increase in cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) levels, leading to prostaglandin production. This eventually leads to PLT aggregation and induces ischemic heart disease. ^{[16, 27, 31]}. However, the rate of H. pylori infection in hypertensive individuals was not associated with age. Some studies have shown that in subjects younger than 36 years of age, increasing age was associated with an increase in H. pylori infection, peaking at 36 years of age. In subjects older than 36 years, the prevalence of H. pylori infection did not vary significantly with age^[18].

The sample size of the current study was sufficiently large and the range of statistical indicators was broad and involved, which revealed that hypertension is associated with H. pylori infection. But there are limitations in our current study. The causal relationship between H. pylori and hypertension cannot be concluded from the current study and further experiments are needed. The current study was unable to include the height and weight and lifestyle habits of the study population, and several studies have shown that H. pylori infection is associated with BMI, with the mean BMI of those with H. pylori infection being higher than those without H. pylori infection ^[32–34].In the study of the correlation between H. pylori and drinking and smoking in daily life, different scholars have different views. Gao and Liu et al believed that appropriate drinking could reduce the infection of H. pylori ^{[35, 36]}, Zhang et al. concluded that alcohol can destroy the gastric mucosa or make H. pylori adhere better to the gastric mucosa and that alcohol consumption can promote H. pylori infection, whereas smoking is not associated with H. pylori infection ^[37]. Wu's study found that whether alcohol consumption and smoking influenced H. pylori infection was correlated with gender, with both alcohol consumption and smoking being risk factors in the male population, but not in the female population ^[38]. The correlation between H. pylori infection and alcohol consumption and smoking needs further study and analysis, which was not addressed in this study, which was a limitation of this study.

This study confirms that the prevalence of H. pylori infection is associated with the prevalence of hypertension. Among patients with established hypertension, males were more likely to be infected with H. pylori and to have a more severe infection in which those with co-infection with H. pylori in hypertensive patients, H. pylori infection was less prevalent in younger people. Within the population of hypertensive and infected with H. pylori, male middle-aged and elderly patients should be given increased attention and timely treatment.

What is known about topic

Some studies have recently indicated that Helicobacter pylori (H. pylori) may cause cardiovascular system diseases in addition to gastric diseases. Current studies have shown that Hp infection may affect the increase of blood pressure. Hp infection can cause water and sodium retention, vascular endothelial injury, etc., which may affect the body's blood pressure and can promote the increase of blood pressure.

What this study adds

In our study, we claried that there is high correlation between H. pylori and blood pressure in patients. People with established hypertension, men are more likely to be infected with H. pylori and to have more severe infections. In contrast, the degree of H. pylori infection is lower in young people(<40 years) than in other people in people with hypertension and infected with H. pylori.

Funding information:

This work was supported by the Science and Technology Research Project of Higher Education Institutions in the Inner Mongolia Autonomous Region (NJZY22069).

Disclosure of interest

No potential conflict of interest was reported by the authors. This study was proposed by Guanhua Huang and was responsible for the overall coordination, with Ping Yang in charge of paper writing, We Shi i in charge of statistical guidance, Chi Wang in charge of research scheme design, Hai Liu in charge of data collation, Xianbin Wang and Zengshuai Wang in charge of data collection, and Guanrong Huang in charge of results analysis.

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There is NO conflict of interest to disclose.

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Helicobacter pylori and hypertension: a cross-sectional study based on a healthy population

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