Low-Level Cumulative Lead and Resistant Hypertension: A Prospective Study of Men Participating in the Veterans Affairs Normative Aging Study.
Background Bone lead offers a better method over blood lead measurement to discern long-term lead exposure and accumulation. We examined the risk of resistant hypertension based on bone lead levels in a prospective cohort study of NAS (Normative Aging Study). Methods and Results Participants had clinic data on hypertension (systolic blood pressure, diastolic blood pressure, and antihypertension medication), lead (blood, bone-patella, bone-tibia), and demographic and confounding variables. Cases of resistant hypertension were identified by meeting criteria for: (1) inadequate systolic blood pressure (>140 mm Hg) or diastolic blood pressure (>90 mm Hg) while taking 3 medications or (2) requiring >4 medications for blood pressure control. A modified Poisson regression was used for model analysis. Of the 475 participants, 97 cases of resistant hypertension (20.4%) were identified. Among the cases of resistant hypertension, the median tibia and patella lead levels were 20 μg/g and 25 μg/g, respectively, while median tibia and patella lead levels were 20 μg/g and 27.5 μg/g, respectively, in participants without resistant hypertension. Tibia lead demonstrated a significant association with resistant hypertension (relative risk, 1.19; 95% confidence interval, 1.01-1.41 [ P=0.04]) per interquartile range increase in tibia lead (13-28.5 μg/g). Patella lead was not associated with resistant hypertension (relative risk, 1.10; 95% confidence interval, 0.92-1.31 [ P=0.31]) per interquartile range increase in patella lead (18-40 μg/g). Blood lead levels were not significantly associated with resistant hypertension (relative risk, 1.11; 95% confidence interval, 0.88-1.40 [ P=0.38]). Conclusions Tibia lead represents a novel risk factor for resistant hypertension. Our study demonstrates an increased association between tibia lead and resistant hypertension status, with an increased risk of 19% per 1 interquartile range increase in tibia lead.
['Zheutlin|Alexander R|AR|', 'Hu|Howard|H|', 'Weisskopf|Marc G|MG|', 'Sparrow|David|D|', 'Vokonas|Pantel S|PS|', 'Park|Sung Kyun|SK|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D015331:Cohort Studies D003329:Coronary Vasospasm D006801:Humans D006973:Hypertension D007854:Lead D008137:Longitudinal Studies D008297:Male D008875:Middle Aged D010329:Patella D011446:Prospective Studies D018570:Risk Assessment D012307:Risk Factors D013977:Tibia D058014:Veterans Health D055815:Young Adult
hypertension environment epidemiology hypertension, high blood pressure