Abstract
The link between lead and blood pressure was debatable, and whether it was mediated by renal function was unknown. The purpose was to investigate the relationship between blood lead concentrations and blood pressure and hypertension, as well as the mediating role of estimated glomerular filtration rate (eGFR) in this relationship. Participants aged 18 were recruited from the National Health and Nutrition Examination Survey (1999–2014) and provided with lead and blood pressure data. Multivariate linear and logistic regression, stratification, interaction tests, and a restricted cubic spline curve were used to assess the association of blood lead with systolic/diastolic blood pressure (SBP/DBP) and hypertension, and mediation effect analysis was used to investigate the role of eGFR in this relationship. A total of 20,073 subjects were enrolled, and among them, 9837 (49.01%) were male and 7800 (38.86%) were hypertensive patients. Multivariate linear and logistic regression analysis showed that blood lead levels were significantly associated with SBP (β = 3.14, 95%CI: 2.03, 4.25; P < 0.001), DBP (β = 3.50, 95%CI: 2.69, 4.30; P < 0.001), and hypertension (OR = 1.29, 95%CI: 1.09, 1.52; P = 0.0026). In comparison to the lowest blood lead quartile, the highest lead group was significantly associated with SBP (= 2.55, 95%CI: 1.66, 3.44; P = 0.0001), DBP (= 2.60, 95%CI: 1.95, 3.24; P = 0.0001), and hypertension (OR = 1.26, 95%CI: 1.10, 1.45; P = 0.0007). Mediation analysis showed that the proportion of blood lead mediated for SBP, DBP, and hypertension was 3.56% (95%CI: 0.42%, 7.96%; P = 0.0320), 6.21% (95%CI: 4.02%, 9.32%; P < 0.0001), and 17.39% (95%CI: 9.34%, 42.71%; P < 0.0001), respectively. Adjusted restricted cubic spline curves presented a non-linear correlation of blood lead levels with DBP (P-non-linearity < 0.001), linear with SBP (P-non-linearity = 0.203), and hypertension (P-non-linearity = 0.763). Our findings demonstrated that blood lead levels were non-linear with DBP, but linear with SBP and hypertension, and this relationship was mediated by eGFR.
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Data availability
Data are available in a public, open access repository. Data availability in https://wwwn.cdc.gov/nchs/nhanes/Default.Aspx.
Abbreviations
- ANOVA:
-
Analysis of variance
- BMI:
-
Body mass index
- CAP:
-
College of American Pathologists
- CI:
-
Confidence interval
- CVD:
-
Cardiovascular disease
- DBP:
-
Diastolic blood pressure
- eGFR:
-
Estimated glomerular filtration rate
- NHANES:
-
National Health and Nutrition Examination Surveys
- OR:
-
Odds ratio
- QA/QC:
-
Quality assurance and quality control
- Q:
-
Quartile
- SBP:
-
Systolic blood pressure
- SCr:
-
Serum creatinine
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Conceptualization and study design: HYQ, HGD, and FYQ. Formal analysis and data download: HGD and HYQ. Paper preparation: HYQ and HGD. Statistical analysis and data interpretation: HGD and HYQ. All authors reviewed and approved this manuscript.
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The NHANES protocols were approved by the institutional review board of the National Center for Health Statistics, Centers for Disease Control and Prevention. The institutional review board of Guangdong Provincial People’s Hospital approved the analysis of anonymous data to be exempt research (KY-Q-2021–244-01).
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Huang, Yq., He, Gd. & Feng, Yq. The association of lead exposure with blood pressure and hypertension: a mediation analyses of estimated glomerular filtration rate. Environ Sci Pollut Res 30, 59689–59700 (2023). https://doi.org/10.1007/s11356-023-26734-7
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DOI: https://doi.org/10.1007/s11356-023-26734-7