Farm workers experience some of the highest chronic pesticide exposures worldwide, yet potential links with key cardiovascular risk factors remain underexplored. This systematic review focuses specifically on associations between occupational pesticide exposure and hypertension or obesity in farm-exposed adult populations, highlighting two major, modifiable cardiovascular risk factors in a high-risk group. MEDLINE was systematically searched for observational studies of hypertension and/or obesity among adults with farm-related pesticide exposure. Using the PECOS framework, two reviewers independently screened records and extracted data on study design, population, exposure assessment, outcomes, and main findings. Of 355 records, 14 studies met inclusion criteria (10 cross-sectional, 2 case–control, 2 cohort). Most assessed general pesticide use ( n = 9), with fewer examining specific pesticide groups, chemical classes, or active ingredients (each n = 4). Obesity was positively associated with organophosphates ( n = 3), atrazine ( n = 1), and general pesticide exposure ( n = 5), while two studies reported inverse associations; no other active ingredient showed consistent effects. General pesticide exposure was associated with hypertension in three studies, but overall evidence for blood pressure was heterogeneous. Occupational exposure to organophosphates, atrazine, and general pesticide use may increase obesity risk among farm workers, suggesting a potential contribution to cardiovascular disease, whereas associations with hypertension remain uncertain. Interpretation is constrained by limited, heterogeneous data and by a predominant focus on compounds now restricted or banned in many high-income settings. Future longitudinal studies should apply standardized, quantitative exposure assessment and evaluate currently used pesticides and mixtures in diverse agricultural contexts.
Ulrich et al. (2026) studied this question.