Association between blood lead and blood pressure: a population-based study in Brazilian adults

BackgroundEnvironmental lead exposure among adults may increase blood pressure and elevate the risk of hypertension. The availability of data on blood lead levels (BLL) in adult Brazilian population is scarce and population-based studies are important for screening the population exposure and also to evaluate associations with adverse health effects. The goal of this study was to examine the association of BLL with blood pressure and hypertension in a population-based study in a city in Southern Brazil.MethodsA total of 948 adults, aged 40 years or older, were randomly selected. Information on socioeconomic, dietary, lifestyle and occupational background was obtained by orally administered household interviews. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured according to the guidelines VI Brazilian Guidelines on Hypertension. BLL were measured by inductively coupled plasma mass spectrometry technique. Multiple linear and logistic regression models were performed to evaluate associations of BLL with SBP and DBP, and with the chance of hypertension and of elevated SBP and DBP.ResultsThe geometric mean of BLL was 1.97 μg/dL (95%CI:1.90-2.04 μg/dL). After multivariable adjustment, participants in the quartile 4 of blood lead presented 0.06 mm/Hg (95%CI, 0.04-0.09) average difference in DBP comparing with those in quartile 1. Participants in the 90th percentile of blood lead distribution had 0.07 mmHg (95% CI, 0.03 to 0.11) higher DBP compared with those participants in the 10th percentile of blood lead. The adjusted OR for hypertension was 2.54 (95% CI, 1.17-5.53), comparing the highest to the lowest blood lead quartiles. Compared with participants in the 10th percentile of blood lead, participants in the 90th percentile presented higher OR for hypertension (OR: 2.77; 95% CI, 1.41 to 5.46).ConclusionAt low concentrations, BLL were positively associated with DBP and with the odds for hypertension in adults aged 40 or older. It is important to enforce lead exposure monitoring and the enactment of regulatory laws to prevent lead contamination in urban settings.

[1]  M. Pande,et al.  Lead induced oxidative damage and its response to combined administration of alpha-lipoic acid and succimers in rats. , 2002, Toxicology.

[2]  Bruce Bartholow Duncan,et al.  Chronic non-communicable diseases in Brazil: burden and current challenges , 2011, The Lancet.

[3]  R. Levy,et al.  Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. , 1972, Clinical chemistry.

[4]  D. Kromhout.  Blood lead and coronary heart disease risk among elderly men in Zutphen, The Netherlands. , 1988, Environmental health perspectives.

[5]  F. Fuchs,et al.  Prevalence of hypertension among elderly persons in urban Brazil: a systematic review with meta-analysis. , 2013, American journal of hypertension.

[6]  M. Scanavacca,et al.  Diretrizes para Avaliação e Tratamento de Pacientes com Arritmias Cardíacas , 2002 .

[7]  L. Rohde,et al.  [Updating of the Brazilian guideline for chronic heart failure - 2012]. , 2012, Arquivos brasileiros de cardiologia.

[8]  N. Vaziri,et al.  Superoxide dismutase, catalase, glutathione peroxidase and NADPH oxidase in lead-induced hypertension. , 2003, Kidney international.

[9]  N. Vaziri,et al.  Mechanisms of Disease: oxidative stress and inflammation in the pathogenesis of hypertension , 2006, Nature Clinical Practice Nephrology.

[10]  Albertino Damasceno,et al.  Hypertension in developing countries , 2012, The Lancet.

[11]  A. Green,et al.  Effects of lead exposure on oxidative stress biomarkers and plasma biochemistry in waterbirds in the field. , 2011, Environmental research.

[12]  Luis E. M. Lima,et al.  I Diretriz de Dor Torácica na Sala de Emergência , 2002 .

[13]  F. McAlister,et al.  Association between blood lead and blood pressure: Results from the Canadian Health Measures Survey (2007 to 2011). , 2014, Health reports.

[14]  N. Vaziri,et al.  Mechanisms of lead-induced hypertension and cardiovascular disease. , 2008, American journal of physiology. Heart and circulatory physiology.

[15]  Ellen K Silbergeld,et al.  Blood lead, blood pressure, and hypertension in perimenopausal and postmenopausal women. , 2003, JAMA.

[16]  N. Lunet,et al.  Differences in prevalence, awareness, treatment and control of hypertension between developing and developed countries , 2009, Journal of hypertension.

[17]  T. Glass,et al.  Association of blood lead and tibia lead with blood pressure and hypertension in a community sample of older adults. , 2006, American journal of epidemiology.

[18]  J. Staessen,et al.  Blood Pressure in Relation to Environmental Lead Exposure in the National Health and Nutrition Examination Survey 2003 to 2010 , 2015, Hypertension.

[19]  P. Sexton,et al.  Molecular Pharmacology , 1965, Nature.

[20]  B. Schwartz,et al.  Adult Lead Exposure: Time for Change , 2006, Environmental health perspectives.

[21]  F. McAlister,et al.  Association between blood lead and blood pressure: Results from the Canadian Health Measures Survey , 2014 .

[22]  T. Kristensen,et al.  Blood lead as a cardiovascular risk factor. , 1992, American journal of epidemiology.

[23]  Brian S. Schwartz,et al.  The Epidemiology of Lead Toxicity in Adults: Measuring Dose and Consideration of Other Methodologic Issues , 2006, Environmental health perspectives.

[24]  Franco Scinicariello,et al.  Association of low-level blood lead and blood pressure in NHANES 1999-2006. , 2011, Environmental research.

[25]  F. Speizer,et al.  The relationship of blood lead to systolic blood pressure in a longitudinal study of policemen. , 1988, Environmental health perspectives.

[26]  M. Cabrera,et al.  Prevalência de fatores de risco cardiovascular em pessoas com 40 anos ou mais de idade, em Cambé, Paraná (2011): estudo de base populacional , 2013 .

[27]  N. Vaziri,et al.  Cardiovascular effects of lead exposure. , 2008, The Indian journal of medical research.

[28]  A. Smith,et al.  Blood pressure and blood lead concentration in bus drivers. , 1988, Environmental health perspectives.

[29]  Bruce A. Fowler,et al.  Modification by ALAD of the Association between Blood Lead and Blood Pressure in the U.S. Population: Results from the Third National Health and Nutrition Examination Survey , 2009, Environmental health perspectives.

[30]  K. Vähäkangas,et al.  Glutamate increases toxicity of inorganic lead in GT1-7 neurons: partial protection induced by flunarizine , 2003, Archives of Toxicology.

[31]  J. Staessen,et al.  An epidemiological re-appraisal of the association between blood pressure and blood lead: a meta-analysis , 2002, Journal of Human Hypertension.

[32]  A. El-Kadi,et al.  The role of redox-sensitive transcription factors NF-kappaB and AP-1 in the modulation of the Cyp1a1 gene by mercury, lead, and copper. , 2008, Free radical biology & medicine.

[33]  E. Silbergeld.  Lead in bone: implications for toxicology during pregnancy and lactation. , 1991, Environmental health perspectives.

[34]  D. Harrison,et al.  Endothelial dysfunction in cardiovascular diseases: the role of oxidant stress. , 2000, Circulation research.

[35]  J. Tanus-Santos,et al.  Clinical evidence for lead-induced inhibition of nitric oxide formation , 2006, Archives of Toxicology.

[36]  J Schwartz,et al.  Lead, blood pressure, and cardiovascular disease in men. , 1995, Archives of environmental health.

[37]  J R Landis,et al.  The relationship between blood lead levels and blood pressure and its cardiovascular risk implications. , 1985, American journal of epidemiology.

[38]  Margareth Crisóstomo Portela,et al.  Transição epidemiológica e o estudo de carga de doença no Brasil , 2004 .

[39]  Denilson Campos de Albuquerque,et al.  Atualização da diretriz brasileira de insuficiência cardíaca crônica - 2012 , 2012 .

[40]  J Schwartz,et al.  Bone lead and blood lead levels in relation to baseline blood pressure and the prospective development of hypertension: the Normative Aging Study. , 2001, American journal of epidemiology.

[41]  W. Harlan.  The relationship of blood lead levels to blood pressure in the U.S. population. , 1988, Environmental health perspectives.

[42]  P. Stolpman,et al.  Environmental Protection Agency , 2020, The Grants Register 2022.

[43]  P. Muntner,et al.  Continued decline in blood lead levels among adults in the United States: the National Health and Nutrition Examination Surveys. , 2005, Archives of internal medicine.

[44]  J. Schwartz,et al.  The relationship between blood lead and blood pressure in the NHANES II survey. , 1988, Environmental health perspectives.

[45]  N. Poulter,et al.  Blood lead and blood pressure: evidence from the Health Survey for England 1995 , 1999, Journal of Human Hypertension.

[46]  N. Vaziri,et al.  INTERPLAY OF REACTIVE OXYGEN SPECIES AND NITRIC OXIDE IN THE PATHOGENESIS OF EXPERIMENTAL LEAD‐INDUCED HYPERTENSION , 2007, Clinical and experimental pharmacology & physiology.

[47]  C. Roberts,et al.  Lead-induced dysregulation of superoxide dismutases, catalase, glutathione peroxidase, and guanylate cyclase. , 2005, Environmental research.

[48]  E. Guallar,et al.  Lead Exposure and Cardiovascular Disease—A Systematic Review , 2006, Environmental health perspectives.

[49]  E. Silbergeld,et al.  Risk Factors for Lead Exposure in Adult Population in Southern Brazil , 2014, Journal of toxicology and environmental health. Part A.

[50]  J. Links,et al.  The Longitudinal Association of Lead with Blood Pressure , 2003, Epidemiology.

[51]  E. D. De Capitani,et al.  Environmental contamination and human exposure to lead in Brazil. , 2005, Reviews of environmental contamination and toxicology.

[52]  Annette Ashizawa,et al.  Toxicological Profile for Lead , 2007 .

[53]  Michigan.,et al.  Toxicological profile for dichloropropenes , 2008 .

[54]  M. Miller.  Agency , 2010 .

[55]  J. Staessen,et al.  The relationship between blood pressure and blood lead in NHANES III , 2002, Journal of Human Hypertension.

[56]  Zongping Liu,et al.  Oxidative stress and apoptotic changes in primary cultures of rat proximal tubular cells exposed to lead , 2009, Archives of Toxicology.

[57]  N. Vaziri,et al.  Lead promotes hydroxyl radical generation and lipid peroxidation in cultured aortic endothelial cells. , 2000, American journal of hypertension.