Key result
Cumulative tibia lead exposure linked to ~19% higher resistant hypertension risk per IQR.
Why the study?
Bone lead measurement offers a better method than blood lead to assess long-term lead exposure and its association with resistant hypertension was unclear.
Cohort (n=475)
No
Relative Risk: 1.19 (95% CI 1.01–1.41)
p-value: p=0.04
Should not yet change practice; extends observational links between bone lead and resistant hypertension while leaving causality open.
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.
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Zheutlin et al. (2018) conducted a cohort in Hypertension (n=475). Tibia lead exposure vs. Lower tibia lead levels (per interquartile range increase) was evaluated on Development of resistant hypertension (inadequate BP control while taking ≥3 medications or adequate control requiring ≥4 medications) (RR 1.19, 95% CI 1.01-1.41, p=0.04). Cumulative tibia lead exposure significantly increased the risk of developing resistant hypertension, demonstrating a 19% increased risk (RR 1.19) per interquartile range increase in tibia lead.
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