Co-morbidity of malaria and hypertension among adults in Nigeria: patterns, mechanisms, and health barriers

This review examined the co-morbidity of malaria and hypertension in Nigerian adults, with a focus on epidemiological trends, genetic and environmental risk factors, pathophysiological mechanisms, and systemic healthcare barriers. A qualitative synthesis of peer-reviewed literature, national health surveys, and institutional reports published between 2000 and 2025 was conducted using thematic analysis. While centered on Nigeria, the review incorporated comparative insights from global studies on renin angiotensin aldosterone system polymorphisms, co-infection dynamics, and health service inequalities. The findings indicate overlapping risk factors including renin angiotensin aldosterone system gene polymorphisms, urbanization, and poverty. Angiotensin II demonstrates dual functions, contributing both to malaria suppression and to hypertension pathogenesis. Clinical challenges include diagnostic overlap, adverse drug interactions, and disparities in service delivery between rural and urban populations. These challenges particularly affect older adults and highlight systemic gaps in access, workforce distribution, and policy alignment. The dual burden of malaria and hypertension in Nigeria requires integrated disease management strategies that address both communicable and non-communicable disease risks. Urgent priorities include multi-sectoral policy reforms, expanded rural health investments, and the adoption of precision medicine approaches guided by genetic profiling. The implications extend to clinical practice through co-screening and tailored treatment protocols and to public health policy, where integrated frameworks are essential to reducing inequities and improving long-term outcomes.