ArticleEnvironmental health and preventive medicine2023
Associations of blood lead, cadmium, and mercury with resistant hypertension among adults in NHANES, 1999-2018.
Article in Environmental health and preventive medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 1 of them a synthesis that pooled it.
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Who cites it
20 citing papers in PubMed, 1 synthesis or guideline pooled it, 29 citations in OpenAlex.
- Relationship between lead exposure and different types of hypertension: systematic review and dose-response meta-analysis.Frontiers in public health · 2025Pooled it
- Effects of Micronutrients and Heavy Metals on Endothelial Function and Cardiovascular Risk in the Face of Environmental Changes.Current issues in molecular biology · 2025Review
- Essential and Toxic Elements in Cardiovascular Disease: Pathophysiological Roles and the Emerging Contribution of Hair Mineral Analysis.International journal of molecular sciences · 2025Review
- The association between whole-blood lead concentration and all-cause or cardiovascular disease mortality in hypertensive patients.Scientific reports · 2025Article
- Association between combined exposure to underground air pollutants and hypertension in coal miners: a cross-sectional study.BMC public health · 2025Article
- Association Between Multiple Plasma Toxic Metal and Metalloid Exposures and Hypertension in Elderly Chinese Adults.Biological trace element research · 2025Article
- Endocrine-disrupting chemicals exposure: cardiometabolic health risk in humans.Cardiovascular diabetology · 2025Review
- Enhanced Kidney Damage in Individuals with Diabetes Who Are Chronically Exposed to Cadmium and Lead: The Emergent Role for βInternational journal of molecular sciences · 2025Article
- Lead-induced hypertension and cognitive dysfunction: brain amyloid pathology.European journal of medical research · 2025Article
- Hypertension in People Exposed to Environmental Cadmium: Roles for 20-Hydroxyeicosatetraenoic Acid in the Kidney.Journal of xenobiotics · 2025Review
- Association between atherogenic index of plasma and hypertension combined with diabetes mellitus in United States adults: an analysis of the NHANES surveys from 2011 to 2016.Journal of health, population, and nutrition · 2025Article
- Effect of combined exposure to lead, mercury, and cadmium on hypertension: The 2008-2013 Korean National Health and Nutrition Examination Surveys.International journal of occupational medicine and environmental health · 2025Article
- The burden and trend prediction of ischemic heart disease associated with lead exposure: Insights from the Global Burden of Disease study 2021.Environmental health : a global access science source · 2025Article
- Baseline associations between exposure to metals and systolic and diastolic blood pressure among women in the Household Air Pollution Intervention Network Trial.medRxiv : the preprint server for health sciences · 2025Article
- Effects of heavy metal exposure on kidney transplant recipients: mechanisms and clinical implications for graft failure risk.Frontiers in immunology · 2025Review
- Selenium and Lead Exposure are Associated with Elevated Blood Pressure in Individuals with Undiagnosed Hypertension: Findings from NHANES 2013-2020.Vascular health and risk management · 2025Article
- Impact of the environmental pollution on cardiovascular diseases: From epidemiological to molecular evidence.Heliyon · 2024Review
- Blood Lead Mediates the Relationship between Biological Aging and Hypertension: Based on the NHANES Database.Nutrients · 2024Article
- The Global Burden of Resistant Hypertension and Potential Treatment Options.European cardiology · 2024Review
- Association between blood cadmium and depression varies by age and smoking status in US adult women: a cross-sectional study from NHANES 2005-2016.Environmental health and preventive medicine · 2024Article
Corrections and comments
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Authors and funding
8 authors at 5 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundResistant hypertension (RHTN), a clinically complex condition with profound health implications, necessitates considerable time and allocation of medical resources for effective management. Unraveling the environmental risk factors associated with RHTN may shed light on future interventional targets aimed at reducing its incidence. Exposure to heavy metal has been linked to an increased risk of hypertension, while the relationship with RHTN remains poorly understood.
methodsUsing the 1999-2018 National Health and Nutrition Examination Survey (NHANES) data, we examined the association of blood lead (Pb), cadmium (Cd), and mercury (Hg) with RHTN using a multinomial logistic regression model. The combined effects of the metals and the contribution of each metal were assessed using a weighted quantile sum (WQS) analysis.
resultsA total of 38281 participants were included in the analysis. Compared with no resistant hypertension (NRHTN), per 1 µg/dL increase in blood Pb concentration, the proportion of RHTN increased by 16% [adjusted odds ratio (aOR), 1.16; 95% confidence interval (CI) 1.01-1.32]. When analyzed by quartiles (Q), the aOR [95% CI] for Pd was 1.30[1.01,1.67] (Q4 vs. Q1); there was a significant dose-response relationship (p < 0.05). Likewise, as a continuous variable, each 1 µg/dL increase in blood Cd level was associated with a 13% increase in the proportion of RHTN (aOR: 1.13; 95%CI: [1.00,1.27]); when analyzed as quartile, aOR [95% CI] for Cd were 1.30[1.01,1.69] (Q3 vs. Q1), and 1.35[1.03,1.75] (Q4 vs. Q1); the dose-response relationship was significant (p < 0.05). WQS analysis showed a significant combined effects of Pb, Cd, and Hg on RHTN, with Pb as the highest weight (0.64), followed by Cd (0.25) and Hg (0.11). Stratified analysis indicated that the associations for the two heavy metals were significant for participants who were male, ≼ 60 years old, and with kidney dysfunction.
conclusionFindings of this study with national data provide new evidence regarding the role of environmental heavy metal exposure in RHTN. The prevention strategies aimed at reducing heavy metal exposure should particularly focus on Americans who are middle-aged, male, and afflicted with kidney dysfunction.
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