Relationship between lead exposure and different types of hypertension: systematic review and dose–response meta-analysis

Background This systematic review and meta-analysis aimed to quantify the association between environmental and occupational lead exposure and the risk of various hypertension subtypes. We further evaluated this relationship through a dose–response analysis to provide a scientific basis for targeted public health interventions. Methods Observational studies on lead exposure and hypertension were searched from Chinese/English databases (inception to June 9, 2025). Two researchers independently screened studies, extracted data, and assessed bias risk. Random-effects meta-analysis calculated pooled ORs (95% CIs); meta-regression/subgroup analyses explored heterogeneity. Egger’s test evaluated publication bias, sensitivity analyses verified result robustness, and dose–response analysis was applied to multi-level exposure data. Result 24 studies (181,500 participants) were included. Lead exposure correlated significantly with hypertension (pooled OR = 1.27, 95% CI: 1.20–1.34) with high heterogeneity (I 2 = 91.4%, p < 0.001). Stronger associations were found for blood lead (OR = 1.32), essential hypertension (OR = 1.31), and resistant hypertension (OR = 1.36); no significant associations for bone lead or gestational hypertension. Hypertension risk rose sharply at blood lead ≥ 0.107 μg/dl, reaching OR = 4.85 at 8.435 μg/dl. Potential publication bias existed, but sensitivity analyses confirmed robustness. Conclusion Lead exposure is a hypertension risk factor with a clear dose–response relationship. It is recommended to include blood lead in hypertension risk assessment and set a blood lead action level of < 0.107 μg/dl for high-risk groups to reduce hypertension burden from lead pollution. Systematic review registration https://inplasy.com/inplasy-2025-9-0008/ .