Protocol for investigating the association between Helicobacter pylori exposure, antigen-specific serological responses, and resistant versus non-resistant hypertension in a South African cohort
11 affiliations
- 1Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa
- 2Department of Virology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- 3Institute of Infectious Disease and Molecular Medicine, Division of Medical Virology, University of Cape Town, Cape Town, South Africa
- 4Cape Heart Institute, University of Cape Town, Cape Town, South Africa
- 5Institute for Life Science and Technology, Hanze University of Applied Sciences, Groningen, Netherlands
- 6Wits Donald Gordon Medical Centre, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- 7Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
- 8Division of Nephrology and Hypertension, Department of Medicine, University of Cape Town, Cape Town, South Africa
- 9Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
- 10Division of Medical Gastroenterology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
- 11South African Medical Research Council, Cape Town, South Africa
Abstract
Background: Hypertension is a leading contributor to cardiovascular morbidity and mortality, with poor control in low- and middle-income countries. Helicobacter pylori (H. pylori) has been associated with hypertension through inflammatory, endothelial, metabolic and immune pathways, but data from sub-Saharan Africa, particularly in resistant hypertension, are limited. Methods: This cross-sectional observational study will enrol 200 adults aged ≥18 at a tertiary academic hospital in Cape Town, South Africa: 80 with resistant hypertension, 80 with non-resistant hypertension and 40 with normotension. Participants will undergo standardised clinical assessment, blood pressure measurement, and collection of blood, urine and saliva. H. pylori exposure will be assessed using the Pylori DuoTect® point-of-care assay, which detects antibodies to CagA and FliD. Laboratory analyses will include lipid profile, inflammatory and nitric oxide-related markers, homocysteine, insulin indices, complete blood count, ghrelin, multiplex cytokine profiling and flow cytometric immunophenotyping. PAXgene® blood RNA samples will be retained for future exploratory analyses. Saliva will undergo exploratory H. pylori antigen testing using CerTest® kits, which are validated for stool rather than saliva. Saliva analysis will be exploratory, and results will not define the primary H. pylori exposure variable. Remaining saliva will be kept for potential future oral microbiome analyses not defined in this protocol. Multivariable logistic regression will evaluate associations between H. pylori exposure and hypertension phenotype, adjusting for demographic, lifestyle, and clinical covariates. Discussion: To our knowledge, this will be the first African study to integrate point-of-care H. pylori serology with detailed clinical, inflammatory, metabolic, and immunological profiling across resistant hypertension, non-resistant hypertension and normotension. Findings may clarify biological pathways linking H. pylori exposure to blood pressure dysregulation and inform future mechanistic and interventional studies.
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BibTeX
@article{mennen2026protocol,
title = {{Protocol for investigating the association between Helicobacter pylori exposure, antigen-specific serological responses, and resistant versus non-resistant hypertension in a South African cohort}},
author = {Mathilda C. Mennen and Michael Z. Zulu and Koketso C. Mabatha and Richard Baguma and Sango Skelem and Nandipha N. Mbundwini and Olukayode O. Aremu and Marguerite Adriaanse and Daphne van Dijk and Preyanka Pillay and Sam Africa and Erika Jones and Mashiko Setshedi and Adrian Brink and Wendy A. Burgers and Ntobeko A. B. Ntusi},
journal = {PLOS One},
year = {2026},
month = nov,
doi = {10.1371/journal.pone.0362215},
url = {https://doi.org/10.1371/journal.pone.0362215},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Protocol for investigating the association between Helicobacter pylori exposure, antigen-specific serological responses, and resistant versus non-resistant hypertension in a South African cohort
AU - Mathilda C. Mennen
AU - Michael Z. Zulu
AU - Koketso C. Mabatha
AU - Richard Baguma
AU - Sango Skelem
AU - Nandipha N. Mbundwini
AU - Olukayode O. Aremu
AU - Marguerite Adriaanse
AU - Daphne van Dijk
AU - Preyanka Pillay
AU - Sam Africa
AU - Erika Jones
AU - Mashiko Setshedi
AU - Adrian Brink
AU - Wendy A. Burgers
AU - Ntobeko A. B. Ntusi
PY - 2026
DA - 2026/11/06
JO - PLOS One
DO - 10.1371/journal.pone.0362215
UR - https://doi.org/10.1371/journal.pone.0362215
AB - Background: Hypertension is a leading contributor to cardiovascular morbidity and mortality, with poor control in low- and middle-income countries. Helicobacter pylori (H. pylori) has been associated with hypertension through inflammatory, endothelial, metabolic and immune pathways, but data from sub-Saharan Africa, particularly in resistant hypertension, are limited. Methods: This cross-sectional observational study will enrol 200 adults aged ≥18 at a tertiary academic hospital in Cape Town, South Africa: 80 with resistant hypertension, 80 with non-resistant hypertension and 40 with normotension. Participants will undergo standardised clinical assessment, blood pressure measurement, and collection of blood, urine and saliva. H. pylori exposure will be assessed using the Pylori DuoTect® point-of-care assay, which detects antibodies to CagA and FliD. Laboratory analyses will include lipid profile, inflammatory and nitric oxide-related markers, homocysteine, insulin indices, complete blood count, ghrelin, multiplex cytokine profiling and flow cytometric immunophenotyping. PAXgene® blood RNA samples will be retained for future exploratory analyses. Saliva will undergo exploratory H. pylori antigen testing using CerTest® kits, which are validated for stool rather than saliva. Saliva analysis will be exploratory, and results will not define the primary H. pylori exposure variable. Remaining saliva will be kept for potential future oral microbiome analyses not defined in this protocol. Multivariable logistic regression will evaluate associations between H. pylori exposure and hypertension phenotype, adjusting for demographic, lifestyle, and clinical covariates. Discussion: To our knowledge, this will be the first African study to integrate point-of-care H. pylori serology with detailed clinical, inflammatory, metabolic, and immunological profiling across resistant hypertension, non-resistant hypertension and normotension. Findings may clarify biological pathways linking H. pylori exposure to blood pressure dysregulation and inform future mechanistic and interventional studies.
SN - 1932-6203
ER -