Abstract
Studies on the possible association between blood pressure and blood lead have reached divergent conclusions. In a previous meta-analysis, a doubling of the blood lead concentration was associated with a 1.0/0.6 mm Hg increase in systolic and diastolic blood pressure (BP). This meta-analysis updates the analysis originally performed in 1994. Articles on the association between BP and blood lead were identified from computer searches from January 1980 to February 2001 using the Medical Literature Analysis and Retrieval System. Of the studies reviewed, 31 provided sufficient details to be considered. The meta-analysis included 58518 subjects recruited from the general population in 19 surveys and from occupationally exposed groups in 12 studies. In all but four studies, the results were adjusted for age, and most studies took into account additional confounding factors such as body mass index and the use of alcohol and medication. Weighted joint P-values were calculated using Stouffer's procedure. The association between BP and blood lead was similar in both men and women. In the combined studies, a two-fold increase in blood lead concentration was associated with a 1.0 mm Hg rise in the systolic pressure (95% CI +0.5 to +1.4 mm Hg; P < 0.001) and with a 0.6 mm Hg increase in the diastolic pressure (95% CI +0.4 to +0.8 mm Hg; P < 0.001). On balance, this meta-analysis suggests that there can only be a weak association between BP and blood lead.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 digital issues and online access to articles
$119.00 per year
only $9.92 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Staessen JA et al. Impairment of renal function with increasing blood lead concentrations in the general population N Engl J Med 1992 327: 151–156
Lin JL, Lim PS . Does lead play a role in the development of renal insufficiency in somepatients with essential hypertension? J Hum Hypertens 1994 8: 495–500
Shaper AG, Pocock SJ . Blood lead and blood pressure Br Med J 1985 291: 1147–1149
Sharp DS, Becker CE, Smith AH . Chronic low-level lead exposure. Its role in the pathogenesis of hypertension Med Toxicol 1987 2: 210–232
Staessen JA et al. Hypertension caused by low-level lead exposure: myth or fact? J Cardiovasc Risk 1994 1: 87–97
Staessen JA, Roels H, Fagard R for the PheeCad Investigators. Lead exposure and conventional and ambulatory blood pressure. A prospective population study JAMA 1996 275: 1563–1570
Pocock SJ et al. The relationship between blood lead, blood pressure, stroke, and heart attacks in middle-aged British men Environ Health Perspect 1988 78: 23–30
Hedges LV, Olkin I . Statistical Methods for Meta-analysis Academic Press Inc, Harcourt Brace Jovanovich Publishers: San Diego, California, USA 1985
Thompson SG, Pocock SJ . Can meta-analyses be trusted? Lancet 1991 338: 1127–1130
U.S. Environmental Protection Agency. Air Quality Criteria for Lead. Volume IV of IV (EPA-600/8-83/028dF). Research Triangle Park, North Carolina, USA: U.S Environmental Protection Agency 1986
Easterbrook PJ, Berlin JA, Gopalan R, Matthews DR . Publication bias in clinical research Lancet 1991 337: 867–872
Needleman HL, Gatsonis CA . Low-level lead exposure and the IQ of children. A meta-analysis of modern studies JAMA 1990 263: 673–678
Apostoli P et al. Blood lead and blood pressure: a cross sectional study in a general population group Cardiologia 1990 35: 597–603
Maheswaran R, Gill JS, Beevers G . Blood pressure and industrial lead exposure Am J Epidemiol 1993 137: 645–653
Harlan WR et al. Blood lead and blood pressure. Relationship in the adolescent and US population JAMA 1985 253: 530–534
Lockett CJ, Arbuckle D . Lead, ferritin, zinc and hypertension Bull Environ Contam Toxicol 1987 38: 975–980
Baker EL et al. Occupational lead poisoning in the United States: clinical and biochemical findings related to blood lead levels Br J Ind Med 1979 36: 314–322
Beevers DG et al. Blood-lead and hypertension Lancet 1976 2: 1–3
Beevers DG et al. Blood-lead and cadmium in human hypertension J Environ Pathol Toxicol 1980 4: 251–260
Bost L et al. Blood lead and blood pressure: evidence from the Health Survey for England 1995 J Hum Hypertens 1999 13: 123–128
Caerphilly and Speedwell Collaborative Group. Caerphilly and Speedwell collaborative heart disease studies J Epidemiol Community Health 1984 38: 259–262
dos Santos AC, Colacciopo S, Dal Bò CMR, dos Santos NA . Occupational exposure to lead, kidney function tests, and blood pressure Am J Ind Med 1994 26: 635–643
Cheng Y et al. Bone lead and blood lead levels in relation to baseline blood pressure and the prospective development of hypertension Am J Epidemiol 2001 153: 164–171
Chu NF et al. Reappraisal of the relation between blood lead concentration and blood pressure among the general population in Taiwan Occup Environ Med 1999 56: 30–33
Jhaveri RC et al. Relationship of blood pressure to blood lead concentrations in small children Pediatrics 1979 63: 674–676
Cramér K, Dahlberg L . Incidence of hypertension among lead workers. A follow-up study based on regular control over 20 years Br J Ind Med 1966 23: 101–104
Cramér K, Goyer RA, Jagenburg R, Wilson MH . Renal ultrastructure, renal function, and parameters of lead toxicity in workers with different periods of lead exposure Br J Ind Med 1974 31: 113–127
de Kort WL et al. Occupational exposure to lead and blood pressure: a study in 105 workers Am J Ind Med 1987 11: 145–156
de Kort WL, Zwennis WC . Blood lead and blood pressure: some implications for the situation in the Netherlands Environ Health Perspect 1988 78: 67–70
deCastro FJ, Medley J . Lead in bone and hypertension Matern Child Health J 1997 1: 199–200
Den Hond E, Nawrot T, Staessen JA . Relation between blood pressure and blood lead in NHANES III. [Abstract] J Hypertens 2001 19 (Suppl 2): S57
Staessen JA et al. Public health implications of environmental exposure to cadmium and lead: an overview of epidemiological studies in Belgium. Working Groups J Cardiovasc Risk 1996 1: 87–97
Dolenc P et al. Low level exposure to lead does not increase blood pressure in the population at large J Hypertens 1993 11: 589–593
Elwood PC et al. Blood pressure and blood lead in surveys in Wales Am J Epidemiol 1988 127: 942–945
Elwood PC et al. Two Welsh surveys of blood lead and blood pressure Environ Health Perspect 1988 78: 119–121
Factor-Litvak P, Graziano J, Stein Z . Blood pressure elevations in a cohort of lead-exposed pregnant women Am J Epidemiol 1992 130: 971–972
Factor-Litvak P, Wasserman G, Kline JK, Graziano J . The Yugoslavia Prospective Study of environmental lead exposure Environ Health Perspect 1999 107: 9–15
Gartside PS . The relationship of blood lead levels and blood pressure in NHANES II: additional calculations Environ Health Perspect 1988 78: 31–34
Granadillo VA et al. The influence of the blood levels of lead, aluminum and vanadium upon the arterial hypertension Clin Chim Acta 1995 233: 47–59
Grandjean P et al. Blood lead-blood pressure relations: alcohol intake and hemoglobin as confounders Am J Epidemiol 1989 129: 732–739
Grandjean P, Jorgensen PJ, Viskum S . Temporal and interindividual variation in erythrocyte zinc-protoporphyrin in lead exposed workers Br J Ind Med 1991 48: 254–257
Harlan WR . The relationship of blood lead levels to blood pressure in the US population Environ Health Perspect 1988 78: 9–13
Hense HW, Filipiak B, Keil U . The association of blood lead and blood pressure in population surveys Epidemiology 1993 4: 173–179
Hu H et al. The relationship of bone and blood lead to hypertension. The Normative Aging Study JAMA 1996 275: 1171–1176
Hu H . Poorly controlled hypertension in a painter with chronic lead toxicity Environ Health Perspect 2001 109: 95–99
Kromhout D et al. Trace metals and coronary heart disease risk indicators in 152 elderly men (the Zutphen study) Am J Epidemiol 1985 122: 378–385
Kromhout D . Blood lead and coronary heart disease risk among elderly men in Zutphen, The Netherlands Environ Health Perspect 1988 78: 43–46
McAllister RG Jr, Michelakis AM, Sandstead HH . Plasma renin activity in chronic plumbism Arch Int Med 1971 127: 919–923
Menditto A et al. Association of blood lead to blood pressure in men aged 55 to 75 years: effect of selected social and biochemical confounders Environ Health Perspect 1994 102 (Suppl 9): 107–111
Moreau T et al. Plombémie et pression artérielle Rev Epidém Méd Soc Santé Publ 1982 30: 395–397
Moreau T et al. Influence of membrane sodium transport upon the relation between blood lead and blood pressure in a general male population Environ Health Perspect 1988 78: 47–51
Morris C, McCarron DA, Bennett WM . Low-level lead exposure, blood pressure, and calcium metabolism Am J Kidney Dis 1990 15: 568–574
Møller L, Kristensen TS . Blood lead as a cardiovascular risk factor Am J Epidemiol 1992 136: 1091–1100
Navah U et al. Relationship of blood lead levels to blood pressure in battery workers Arch Environ Health 1996 51: 324–328
Neri LC, Hewitt D, Orser B . Blood lead and blood pressure: analysis of cross-sectional and longitudinal data from Canada Environ Health Perspect 1988 78: 123–126
Orssaud G et al. Blood lead concentrations and blood pressure Br Med J 1985 290: 244
Parkinson DK et al. Occupational lead exposure and blood pressure Br J Ind Med 1987 44: 744–748
Pirkle JL, Schwartz J, Landis JR, Harlan WR . The relationship between blood lead levels and blood pressure and its cardiovascular risk implications Am J Epidemiol 1985 121: 246–258
Pocock SJ et al. Blood lead concentration, blood pressure, and renal function Br Med J 1984 289: 872–874
Proctor SP et al. The relationship of blood lead and dietary calcium to blood pressure in the Normative Aging Study Int J Epidemiol 1996 25: 528–536
Rabinowitz M et al. Pregnancy hypertension, blood pressure during labor, and blood lead levels Hypertension 1987 10: 447–451
Ramirez-Cervantes B et al. Health assessment of employees with different body burdens of lead J Occup Méd 1978 20: 610–617
Reimer W, Tittelbach U . Verhalten von Herzfrequenz, Blutdruck und systolischen Zeitintervallen in Ruhe und während Einhandarbeit bei Bleiexponierten und Kontrollpersonen Z Gesamte Hyg 1989 35: 491–492
Rothenberg SJ et al. Effects of blood lead level and bone lead concentration on maternal blood pressure during pregnancy Anesthesiology 1997 87: A871
Rothenberg SJ et al. Blood lead level and blood pressure during pregnancy in South Central Los Angeles Arch Environ Health 1999 54: 382–389
Sandstead HH, Michelakis AM, Temple TE . Lead intoxication. Its effect on the renin-aldosterone response to sodium deprivation Arch Environ Health 1970 20: 356–363
Schuhmacher M, Bosque MA, Domingo JL, Corbella J . Effects of chronic lead and cadmium exposure on blood pressure in occupationally exposed workers Biol Trace Elem Res 1994 41: 269–277
Schwartz BS, Stewart WF . Different associations of blood lead, meso 2,3-dimercaptosuccinic acid (DMSA)-chelatable lead, and tibial lead levels with blood pressure in 543 former organolead manufacturing workers Arch Environ Health 2000 55: 85–92
Schwartz J . The relationship between blood lead and blood pressure in the NHANES II survey Environ Health Perspect 1988 78: 15–22
Schwartz J . Lead, blood pressure, and cardiovascular disease in men Arch Environ Health 1995 50: 31–37
Shaper AG et al. British Regional Heart Study: cardiovascular risk factors in middle-aged men in 24 towns Br Med J 1981 283: 179–187
Sharp DS et al. Blood pressure and blood lead concentration in bus drivers Environ Health Perspect 1988 78: 131–137
Sharp DS et al. Elevated blood pressure in treated hypertensives with low-level lead accumulation Arch Environ Health 1989 44: 18–22
Sharp DS et al. Influence of race, tobacco use, and caffeine use on the relation between blood pressure and blood lead concentration Am J Epidemiol 1990 131: 845–854
Sokas RK et al. Lead levels in Maryland construction workers Am J Ind Med 1997 31: 188–194
Sorel JE et al. Black-white differences in blood pressure among participants in NHANES II: the contribution of blood lead Epidemiology 1991 2: 348–352
Sparrow D et al. Trace metals in drinking water: lack of influence on blood pressure J Chron Dis 1984 37: 59–65
Staessen J et al. Urinary cadmium and lead concentrations and their relation to blood pressure in a population with low exposure Br J Ind Med 1984 41: 241–248
Staessen J et al. Blood lead concentration, renal function, and blood pressure in London civil servants Br J Ind Med 1990 47: 442–447
Staessen JA et al. Environmental lead exposure does not increase blood pressure in the population at large: evidence from the Cadmibel Study J Hypertens 1993 11 (Suppl 2): S35–S41
Stern AH . Derivation of a target concentration of Pb in soil based on elevation of adult blood pressure Risk Anal 1996 16: 201–210
Victery W . Evidence for effects of chronic lead exposure on blood pressure in experimental animals: an overview Environ Health Perspect 1988 78: 71–76
Wedeen RP, Mallik DK, Batuman V . Detection and treatment of occupational lead nephropathy Arch Int Med 1979 139: 53–57
Weiss ST et al. The relationship of blood lead to blood pressure in a longitudinal study of working men Am J Epidemiol 1986 123: 800–808
Weiss ST et al. The relationship of blood lead to systolic blood pressure in a longitudinal study of policemen Environ Health Perspect 1988 78: 53–56
Wolf C et al. Effect of lead on blood pressure in occupationally nonexposed men Am J Ind Med 1995 27: 897–903
Wu TN et al. Occupational lead exposure and blood pressure Int J Epidemiol 1996 25: 791–796
Medeiros DM, Pellum LK . Blood pressure and hair cadmium, lead, copper, and zinc concentrations in Mississippi adolescents Bull Environ Contam Toxicol 1985 34: 163–169
Ravnskov U . Cholesterol lowering trials in coronary heart disease: frequency of citation and outcome Br Med J 1992 305: 15–19
Staessen JA, O'Brien ET, Thijs L, Fagard RH . Modern approaches to blood pressure measurement Occup Environ Med 2000 57: 510–520
Roels HA et al. Urinary kallikrein activity in workers exposed to cadmium, lead, or mercury vapour Br J Ind Med 1990 47: 331–337
Goldstein GW, Ar D . Lead activates calmodulin sensitive processes Life Sci 1983 33: 1001–1006
Iannaccone A, Carmignani M, Boscolo P . Neurogenic and humoral mechanisms in arterial hypertension of chronically lead exposed rats Med Lavoro 1981 1: 13–21
Vaziri ND, Liang K, Ding Y . Increased nitric oxide inactivation by reactive oxygen species in lead-induced hypertension Kidney Int 1999 56: 1492–1498
Vazari ND, Ding Y . Effect of lead on nitric oxide synthase expression in coronary endothelial cells Hypertension 2001 37: 223–226
Acknowledgements
The International Lead and Zinc Research Organization (ILZRO, Research Triangle Park, North Carolina, USA) supported this study. The secretarial assistance of Mrs R Wolfs, S Van Hulle, L De Pauw and Y Toremans is gratefully acknowledged. Thanks also to Dr Paola Primatesta, Department of Epidemiology and Public Health, University College London Medical School for providing additional information on the Health Survey for England.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Nawrot, T., Thijs, L., Den Hond, E. et al. An epidemiological re-appraisal of the association between blood pressure and blood lead: a meta-analysis. J Hum Hypertens 16, 123–131 (2002). https://doi.org/10.1038/sj.jhh.1001300
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.jhh.1001300
Keywords
This article is cited by
-
Review Article on Molecular Mechanism of Regulation of Hypertension by Macro-elements (Na, K, Ca and Mg), Micro-elements/Trace Metals (Zn and Cu) and Toxic Elements (Pb and As)
Biological Trace Element Research (2024)
-
Public and occupational health risks related to lead exposure updated according to present-day blood lead levels
Hypertension Research (2023)
-
Co-exposure to Heavy Metals and Hypertension Among Adults in South Korea
Exposure and Health (2022)
-
Environmental toxic metal contaminants and risk of stroke: a systematic review and meta-analysis
Environmental Science and Pollution Research (2022)
-
Blood lead level and risk of hypertension in the United States National Health and Nutrition Examination Survey 1999–2016
Scientific Reports (2021)