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July 23/30, 2003

Blood Lead Levels and Hypertension

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;290(4):460. doi:10.1001/jama.290.4.460-a

In Reply: Dr Hense points out that many factors play a role in hypertension. A major issue in previous studies of blood lead concentration and blood pressure has been whether to control for hemoglobin level, which appears to be an established determinant of blood lead concentration, but whose relationship to blood pressure has not been clearly established.1 However, consideration of hemoglobin is complicated by the fact that lead is known to decrease hemoglobin levels, presumably through inhibition of biosynthesis of heme.2 Thus, to enter hemoglobin into the regression model may in fact introduce problems of adjustment for factors along the causal pathway between lead exposure and its effect on blood pressure, or even colinearity.