Department of Molecular Pharmacology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, 10461 Bronx, NY, USA.
Graduate Program in Public Health, Center of Health Sciences, State University of Londrina, 60 Robert Koch Avenue, 86038-350 Londrina, PR, Brazil.
Ecotoxicol Environ Saf. 2021 Jan 15;208:111636. doi: 10.1016/j.ecoenv.2020.111636. Epub 2020 Nov 20.
Since the first report by Perry et al. (1955), most studies affirmed the hypertensive effects of cadmium (Cd) in humans. Nonetheless, conclusions between studies remain inconsistent.
The aim of this study was to reevaluate the evidence for a potential relationship between Cd exposure and altered blood pressure and/or hypertension, focusing on studies published between January 2010 and March 2020.
We reviewed all observational studies from database searches (PubMed and SCOPUS) on Cd exposure and blood pressure or hypertension. We extracted information from studies that provided sufficient data on population characteristics, smoking status, exposure, outcomes, and design.
Thirty-eight studies met our inclusion criteria; of those, twenty-nine were cross sectional, three case control, five cohort and one interventional study. Blood or urinary Cd levels were the most commonly used biomarkers.
A positive association between blood Cd levels and blood pressure and/or hypertension was identified in numerous studies at different settings. Limited number of representative population-based studies of never-smokers was observed, which may have confounded our conclusions. The association between urinary Cd and blood pressure and/or hypertension remains uncertain due to conflicting results, including inverse relationships with lack of strong mechanistic support. We point to the urgent need for additional longitudinal studies to confirm our findings.
自 Perry 等人（1955 年）首次报告以来，大多数研究都证实了镉（Cd）对人类的升压作用。然而，研究间的结论仍然不一致。
本研究旨在重新评估 Cd 暴露与血压改变和/或高血压之间潜在关系的证据，重点关注 2010 年 1 月至 2020 年 3 月期间发表的研究。
我们对数据库（PubMed 和 SCOPUS）中关于 Cd 暴露与血压或高血压的所有观察性研究进行了回顾。我们从提供人群特征、吸烟状况、暴露、结局和设计等方面充足数据的研究中提取信息。
符合纳入标准的研究有 38 项；其中，29 项为横断面研究，3 项为病例对照研究，5 项为队列研究，1 项为干预性研究。血液或尿液 Cd 水平是最常用的生物标志物。
在不同环境下的大量研究中，均发现血液 Cd 水平与血压和/或高血压之间存在正相关。我们观察到很少有代表性的、基于人群的从不吸烟人群的研究，这可能会使我们的结论产生偏倚。由于缺乏强有力的机制支持，尿液 Cd 与血压和/或高血压之间的关系仍不确定，结果相互矛盾。我们指出迫切需要开展更多的纵向研究来证实我们的发现。
