Huang Yu-Qing, He Guo-Dong, Feng Ying-Qing
Hypertension Research Laboratory, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan Two Road, Yuexiu District, Guangzhou, 510080, China.
Department of Cardiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Environ Sci Pollut Res Int. 2023 May;30(21):59689-59700. doi: 10.1007/s11356-023-26734-7. Epub 2023 Apr 4.
The link between lead and blood pressure was debatable, and whether it was mediated by renal function was unknown. The purpose was to investigate the relationship between blood lead concentrations and blood pressure and hypertension, as well as the mediating role of estimated glomerular filtration rate (eGFR) in this relationship. Participants aged 18 were recruited from the National Health and Nutrition Examination Survey (1999-2014) and provided with lead and blood pressure data. Multivariate linear and logistic regression, stratification, interaction tests, and a restricted cubic spline curve were used to assess the association of blood lead with systolic/diastolic blood pressure (SBP/DBP) and hypertension, and mediation effect analysis was used to investigate the role of eGFR in this relationship. A total of 20,073 subjects were enrolled, and among them, 9837 (49.01%) were male and 7800 (38.86%) were hypertensive patients. Multivariate linear and logistic regression analysis showed that blood lead levels were significantly associated with SBP (β = 3.14, 95%CI: 2.03, 4.25; P < 0.001), DBP (β = 3.50, 95%CI: 2.69, 4.30; P < 0.001), and hypertension (OR = 1.29, 95%CI: 1.09, 1.52; P = 0.0026). In comparison to the lowest blood lead quartile, the highest lead group was significantly associated with SBP (= 2.55, 95%CI: 1.66, 3.44; P = 0.0001), DBP (= 2.60, 95%CI: 1.95, 3.24; P = 0.0001), and hypertension (OR = 1.26, 95%CI: 1.10, 1.45; P = 0.0007). Mediation analysis showed that the proportion of blood lead mediated for SBP, DBP, and hypertension was 3.56% (95%CI: 0.42%, 7.96%; P = 0.0320), 6.21% (95%CI: 4.02%, 9.32%; P < 0.0001), and 17.39% (95%CI: 9.34%, 42.71%; P < 0.0001), respectively. Adjusted restricted cubic spline curves presented a non-linear correlation of blood lead levels with DBP (P-non-linearity < 0.001), linear with SBP (P-non-linearity = 0.203), and hypertension (P-non-linearity = 0.763). Our findings demonstrated that blood lead levels were non-linear with DBP, but linear with SBP and hypertension, and this relationship was mediated by eGFR.
铅与血压之间的联系存在争议，其是否通过肾功能介导尚不清楚。目的是研究血铅浓度与血压及高血压之间的关系，以及估算肾小球滤过率（eGFR）在这种关系中的中介作用。从国家健康与营养检查调查（1999 - 2014年）中招募18岁的参与者，并提供铅和血压数据。采用多元线性和逻辑回归、分层、交互作用检验以及受限立方样条曲线来评估血铅与收缩压/舒张压（SBP/DBP）及高血压的关联，并采用中介效应分析来研究eGFR在这种关系中的作用。共纳入20,073名受试者，其中男性9837名（49.01%），高血压患者7800名（38.86%）。多元线性和逻辑回归分析表明，血铅水平与SBP（β = 3.14，95%CI：2.03，4.25；P < 0.001）、DBP（β = 3.50，95%CI：2.69，4.30；P < 0.001）及高血压（OR = 1.29，95%CI：1.09，1.52；P = 0.0026）显著相关。与最低血铅四分位数相比，最高铅组与SBP（= 2.55，95%CI：1.66，3.44；P = 0.0001）、DBP（= 2.60，95%CI：1.95，3.24；P = 0.0001）及高血压（OR = 1.26，95%CI：1.10，1.45；P = 0.0007）显著相关。中介分析表明，血铅对SBP、DBP和高血压的中介比例分别为3.56%（95%CI：0.42%，7.96%；P = 0.0320）、6.21%（95%CI：4.02%，9.32%；P < 0.0001）和17.39%（95%CI：9.34%，42.71%；P < 0.0001）。调整后的受限立方样条曲线显示血铅水平与DBP呈非线性相关（P - 非线性 < 0.001），与SBP呈线性相关（P - 非线性 = 0.203），与高血压呈线性相关（P - 非线性 = 0.763）。我们的研究结果表明，血铅水平与DBP呈非线性关系，但与SBP和高血压呈线性关系，且这种关系由eGFR介导。
