RC8.4 - ECE_3813 - Exposure to per- and polyfluoroalkyl substances and Its association with blood pressure: insights from patients with endocrine and essential hypertension

Background Per- and polyfluoroalkyl substances (PFAS) have been associated with an increased risk of arterial hypertension. However, their role in endocrine forms of hypertension remains insufficiently characterized. Objective To analyze serum PFAS concentrations, temporal trends, and their association with blood pressure (BP) in patients with primary aldosteronism (PA) and Cushing syndrome (CS), and respective controls. Methods This retrospective study included patients with CS (n = 90) and controls with excluded CS (n = 94) from the German Cushing Registry (CS cohort), and patients with PA (n = 389) and controls with excluded PA (n = 165) from the German Conn Registry (PA cohort) at the LMU University Hospital Munich. Serum samples collected at the timepoint of diagnosis between 2012 and 2024 were analyzed for nine different PFAS using liquid chromatography–tandem mass spectrometry (LC-MS/MS). In both cohorts, each including patients and respective controls, multiple linear regression models were used to assess the overall association between log-transformed PFAS concentrations and systolic and diastolic BP across different hormonal states. Models were further adjusted for disease status and corticosteroid concentrations as well as for age, sex, BMI, antihypertensive medication, year of sampling and smoking status. Results Most detected PFAS were perfluorooctane sulfonate (PFOS), perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA), and perfluorohexane sulfonate (PFHxS) in both cohorts. Concentrations of those four were strongly intercorrelated and consistently higher in males compared to females (all P < .05). Summed PFAS (∑PFAS) were correlated with higher age and earlier year of blood sampling in both cohorts (all P < .05). In crude models, higher ∑PFAS concentrations were associated with higher systolic BP in both cohorts (CS: β = 4.26, P = .03; PA: β = 3.59, P = .01). However, these associations were no longer statistically significant upon adjustment for age. In fully adjusted analyses, neither total PFAS nor individual compounds were independently associated with systolic or diastolic blood pressure. Conclusions The findings of this study suggest that within two independent, predominantly hypertensive populations, PFAS exposure correlates with age and sampling year, but does not contribute additional explanatory value for blood pressure beyond clinical and endocrine determinants.