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Nash D, Magder L, Lustberg M, et al. Blood Lead, Blood Pressure, and Hypertension in Perimenopausal and Postmenopausal Women. JAMA. 2003;289(12):1523–1532. doi:10.1001/jama.289.12.1523
Author Affiliations: Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore (Drs Nash, Magder, Lustberg, Sherwin, and Silbergeld); New York City Department of Health and Mental Hygiene, HIV/AIDS Surveillance and Epidemiology Program, New York (Dr Nash); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, La (Dr Sherwin); Department of Environmental Health Sciences, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md (Dr Rubin); and National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Ga (Dr Kaufmann). Dr Silbergeld is now with the Department of Environmental Health Sciences, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md.
Context Lead exposures have been shown to be associated with increased blood
pressure and risk of hypertension in older men. In perimenopausal women, skeletal
lead stores are an important source of endogenous lead exposure due to increased
Objective To examine the relationship of blood lead level with blood pressure
and hypertension prevalence in a population-based sample of perimenopausal
and postmenopausal women in the United States.
Design, Setting, and Participants Cross-sectional sample of 2165 women aged 40 to 59 years, who participated
in a household interview and physical examination, from the Third National
Health and Nutrition Examination Survey conducted from 1988 to 1994.
Main Outcome Measures Associations of blood lead with blood pressure and hypertension, with
age, race and ethnicity, cigarette smoking status, body mass index, alcohol
use, and kidney function as covariates.
Results A change in blood lead levels from the lowest (quartile 1: range, 0.5-1.6
µg/dL) to the highest (quartile 4: range, 4.0-31.1 µg/dL) was
associated with small statistically significant adjusted changes in systolic
and diastolic blood pressures. Women in quartile 4 had increased risks of
diastolic (>90 mm Hg) hypertension (adjusted odds ratio [OR], 3.4; 95% confidence
interval [CI], 1.3-8.7), as well as moderately increased risks for general
hypertension (adjusted OR, 1.4; 95% CI, 0.92-2.0) and systolic (>140 mm Hg)
hypertension (adjusted OR, 1.5; 95% CI, 0.72-3.2). This association was strongest
in postmenopausal women, in whom adjusted ORs for diastolic hypertension increased
with increasing quartile of blood lead level compared with quartile 1 (adjusted
OR, 4.6; 95% CI, 1.1-19.2 for quartile 2; adjusted OR, 5.9; 95% CI, 1.5-23.1
for quartile 3; adjusted OR, 8.1; 95% CI, 2.6-24.7 for quartile 4).
Conclusions At levels well below the current US occupational exposure limit guidelines
(40 µg/dL), blood lead level is positively associated with both systolic
and diastolic blood pressure and risks of both systolic and diastolic hypertension
among women aged 40 to 59 years. The relationship between blood lead level
and systolic and diastolic hypertension is most pronounced in postmenopausal
women. These results provide support for continued efforts to reduce lead
levels in the general population, especially women.
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