Associations between urinary cadmium levels, blood pressure, and hypertension: the ESTEBAN survey

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Cadmium is inconsistently associated with blood pressure (BP) and hypertension. Our study focuses to understand the association between urinary cadmium levels, blood pressure, and hypertension in a French representative sample. Our study included 2015 subjects from the ESTEBAN survey (2014–2015) with measured urinary cadmium. Associations between natural logarithm-transformed cadmium levels and BP (systolic (SBP) and diastolic blood pressure (DBP)) were performed by adjusted linear regression models. Associations between cadmium and hypertension were performed by adjusted logistic regression models. Models were stratified by gender, smoking habits, body mass index (BMI), and kidney function categories. Men present higher SBP (131.7 vs. 121.5 mmHg, p < 0.0001) and DBP (78.9 vs. 74.7 mmHg, p < 0.0001) in comparison to women. Creatinine-adjusted urinary cadmium levels (0.48 vs. 0.39 μg/L, p < 0.0001) were higher in hypertensive subjects. Nevertheless, no difference was observed after adjustment for age, gender, and smoking habits. No correlation between urinary cadmium, BP, and hypertension was observed in overall population. Stratified models showed inverse correlations between urinary cadmium and hypertension among obese (OR = 0.39, 95% CI [0.21–0.57], p = 0.0009), chronic kidney function (OR = 0.68 95%CI [0.75–0.97], p = 0.003), and current smokers (OR = 0.78, 95% CI [0.64–0.92], p = 0.04). A correlation between urinary cadmium levels, BP, and hypertension is observed in subpopulations. Nevertheless, directions and significance of these associations differs by gender, BMI, smoking, and kidney function categories.

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Systolic blood pressure


Diastolic blood pressure


creatinine-adjusted UCd measure


Urinary cadmium level


  1. Andra SS, Makris KC, Charisiadis P, Costa CN (2014) Co-occurrence profiles of trace elements in potable water systems: a case study. Environ Monit Assess 186:7307–7320.

  2. Authors/Task Force Members, Catapano AL, Graham I et al (2016) 2016 ESC/eas guidelines for the management of dyslipidaemias: the task force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Atherosclerosis 253:281–344.

  3. Balicco A, Oleko A, Boschat L et al (2017) Esteban design: a cross-sectional health survey about environment, biomonitoring, physical activity and nutrition (2014-2016). Toxicologie Analytique Et Clinique 29:517–537.

  4. Buchet JP, Lauwerys R, Roels H, et al (1990) Renal effects of cadmium body burden of the general population. Lancet Lond Engl 336:699–702.

  5. Buser MC, Ingber SZ, Raines N, Fowler DA, Scinicariello F (2016) Urinary and blood cadmium and lead and kidney function: NHANES 2007-2012. Int J Hyg Environ Health 219:261–267.

  6. Gallagher CM, Meliker JR (2010) Blood and urine cadmium, blood pressure, and hypertension: a systematic review and meta-analysis. Environ Health Perspect 118:1676–1684.

  7. Gao Y, Zhu X, Shrubsole MJ et al (2018) The modifying effect of kidney function on the association of cadmium exposure with blood pressure and cardiovascular mortality: NHANES 1999-2010. Toxicol Appl Pharmacol 353:15–22.

  8. Garner R, Levallois P (2016) Cadmium levels and sources of exposure among Canadian adults. Health Rep 27:10–18

  9. Garner RE, Levallois P (2017) Associations between cadmium levels in blood and urine, blood pressure and hypertension among Canadian adults. Environ Res 155:64–72.

  10. Hirayama A, Konta T, Kamei K, Suzuki K, Ichikawa K, Fujimoto S, Iseki K, Moriyama T, Yamagata K, Tsuruya K, Kimura K, Narita I, Kondo M, Asahi K, Kurahashi I, Ohashi Y, Watanabe T (2015) Blood pressure, proteinuria, and renal function decline: associations in a large community-based population. Am J Hypertens 28:1150–1156.

  11. Järup L (2003) Hazards of heavy metal contamination. Br Med Bull 68:167–182.

  12. Järup L, Akesson A (2009) Current status of cadmium as an environmental health problem. Toxicol Appl Pharmacol 238:201–208.

  13. Järup L, Berglund M, Elinder CG et al (1998) Health effects of cadmium exposure--a review of the literature and a risk estimate. Scand J Work Environ Health 24(Suppl 1):1–51

  14. Kalra PA (2007) Renal specific secondary hypertension. J Ren Care 33:4–10

  15. Kazancioğlu R (2013) Risk factors for chronic kidney disease: an update. Kidney Int Suppl 3:368–371.

  16. Ketteler M, Block GA, Evenepoel P, Fukagawa M, Herzog CA, McCann L, Moe SM, Shroff R, Tonelli MA, Toussaint ND, Vervloet MG, Leonard MB (2018) Diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder: synopsis of the kidney disease: improving global outcomes 2017 clinical practice guideline update. Ann Intern Med 168:422–430.

  17. Lea JP, Nicholas SB (2002) Diabetes mellitus and hypertension: key risk factors for kidney disease. J Natl Med Assoc 94:7S–15S

  18. Lee DH, Ha MH, Kim JR, Jacobs DR (2001) Effects of smoking cessation on changes in blood pressure and incidence of hypertension: a 4-year follow-up study. Hypertension 37:194–198

  19. McKenzie JM, Kay DL (1973) Urinary excretion of cadmium, zinc and copper in normotensive and hypertensive women. N Z Med J 78:68–70

  20. Nakagawa H, Nishijo M (1996) Environmental cadmium exposure, hypertension and cardiovascular risk. J Cardiovasc Risk 3:11–17

  21. Nordberg GF, Fowler BA, Nordberg M (2014) Handbook on the toxicology of metals. Academic Press, Cambridge, Massachusetts, US.

  22. O’Brien KM, Upson K, Cook NR, Weinberg CR (2016) Environmental chemicals in urine and blood: improving methods for creatinine and lipid adjustment. Environ Health Perspect 124:220–227.

  23. Oliver-Williams C, Howard AG, Acien AN et al (2018) Cadmium body burden, hypertension, and changes in blood pressure over time: results from a prospective cohort study in American Indians. J Am Soc Hypertens.

  24. Padilla MA, Elobeid M, Ruden DM, Allison DB (2010) An examination of the association of selected toxic metals with total and central obesity indices: NHANES 99-02. Int J Environ Res Public Health 7:3332–3347.

  25. Perry HM, Erlanger M, Perry EF (1979) Increase in the systolic pressure of rats chronically fed cadmium. Environ Health Perspect 28:251–260.

  26. Roels HA, Lauwerys RR, Bernard AM et al (1991) Assessment of the filtration reserve capacity of the kidney in workers exposed to cadmium. Br J Ind Med 48:365–374.

  27. Rydén L, Grant PJ, Anker SD et al (2013) ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: the task force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD). Eur Heart J 34:3035–3087.

  28. Satarug S, Vesey DA, Gobe GC (2017) Kidney cadmium toxicity, diabetes and high blood pressure: the perfect storm. Tohoku J Exp Med 241:65–87.

  29. Swaddiwudhipong W, Mahasakpan P, Limpatanachote P, Krintratun S (2010) Correlations of urinary cadmium with hypertension and diabetes in persons living in cadmium-contaminated villages in northwestern Thailand: a population study. Environ Res 110:612–616.

  30. Vallée A, Gabet A, Deschamps V et al (2019a) Relationship between nutrition and alcohol consumption with blood pressure: the ESTEBAN survey. Nutrients 11.

  31. Vallée A, Perrine A-L, Deschamps V et al (2019b) Relationship between dynamic changes in body weight and blood pressure: the ESTEBAN survey. Am J Hypertens.

  32. Weaver VM, Kim N-S, Jaar BG, Schwartz BS, Parsons PJ, Steuerwald AJ, Todd AC, Simon D, Lee BK (2011a) Associations of low-level urine cadmium with kidney function in lead workers. Occup Environ Med 68:250–256.

  33. Weaver VM, Kim N-S, Lee B-K, Parsons PJ, Spector J, Fadrowski J, Jaar BG, Steuerwald AJ, Todd AC, Simon D, Schwartz BS (2011b) Differences in urine cadmium associations with kidney outcomes based on serum creatinine and cystatin C. Environ Res 111:1236–1242.

  34. Wester PO (1973) Trace elements in serum and urine from hypertensive patients before and during treatment with chlorthalidone. Acta Med Scand 194:505–512

  35. Whittemore AS, DiCiccio Y, Provenzano G (1991) Urinary cadmium and blood pressure: results from the NHANES II survey. Environ Health Perspect 91:133–140.

  36. WHO (2000) International guide for monitoring alcohol consumption and related harm. WHO, Geneva

  37. Williams B, Mancia G, Spiering W et al (2018) 2018 practice guidelines for the management of arterial hypertension of the European Society of Hypertension and the European Society of Cardiology: ESH/ESC task force for the Management of Arterial Hypertension. J Hypertens 36:2284–2309.

  38. Yan P, Zhu X, Li H, Shrubsole MJ, Shi H, Zhang MZ, Harris RC Jr, Hao CM, Dai Q (2012) Association of high blood pressure with renal insufficiency: role of albuminuria, from NHANES, 1999-2006. PLoS One 7:e37837.

  39. You L, Zhu X, Shrubsole MJ, Fan H, Chen J, Dong J, Hao CM, Dai Q (2011) Renal function, bisphenol a, and alkylphenols: results from the National Health and Nutrition Examination Survey (NHANES 2003-2006). Environ Health Perspect 119:527–533.

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Correspondence to Alexandre Vallée.

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Vallée, A., Gabet, A., Grave, C. et al. Associations between urinary cadmium levels, blood pressure, and hypertension: the ESTEBAN survey. Environ Sci Pollut Res (2020) doi:10.1007/s11356-019-07249-6

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  • Hypertension
  • Blood pressure
  • Urinary cadmium