Department of Occupational and Environmental Health, School of Public Health, Guangxi Medical University.
Department of Microbiology and Immunology, Miller School of Medicine, University of Miami.
Environ Health Prev Med. 2023;28:66. doi: 10.1265/ehpm.23-00151.
Resistant hypertension (RHTN), a clinically complex condition with profound health implications, necessitates considerable time and allocation of medical resources for effective management. Unraveling the environmental risk factors associated with RHTN may shed light on future interventional targets aimed at reducing its incidence. Exposure to heavy metal has been linked to an increased risk of hypertension, while the relationship with RHTN remains poorly understood.
Using the 1999-2018 National Health and Nutrition Examination Survey (NHANES) data, we examined the association of blood lead (Pb), cadmium (Cd), and mercury (Hg) with RHTN using a multinomial logistic regression model. The combined effects of the metals and the contribution of each metal were assessed using a weighted quantile sum (WQS) analysis.
A total of 38281 participants were included in the analysis. Compared with no resistant hypertension (NRHTN), per 1 µg/dL increase in blood Pb concentration, the proportion of RHTN increased by 16% [adjusted odds ratio (aOR), 1.16; 95% confidence interval (CI) 1.01-1.32]. When analyzed by quartiles (Q), the aOR [95% CI] for Pd was 1.30[1.01,1.67] (Q4 vs. Q1); there was a significant dose-response relationship (p < 0.05). Likewise, as a continuous variable, each 1 µg/dL increase in blood Cd level was associated with a 13% increase in the proportion of RHTN (aOR: 1.13; 95%CI: [1.00,1.27]); when analyzed as quartile, aOR [95% CI] for Cd were 1.30[1.01,1.69] (Q3 vs. Q1), and 1.35[1.03,1.75] (Q4 vs. Q1); the dose-response relationship was significant (p < 0.05). WQS analysis showed a significant combined effects of Pb, Cd, and Hg on RHTN, with Pb as the highest weight (0.64), followed by Cd (0.25) and Hg (0.11). Stratified analysis indicated that the associations for the two heavy metals were significant for participants who were male, ≼ 60 years old, and with kidney dysfunction.
Findings of this study with national data provide new evidence regarding the role of environmental heavy metal exposure in RHTN. The prevention strategies aimed at reducing heavy metal exposure should particularly focus on Americans who are middle-aged, male, and afflicted with kidney dysfunction.
耐药性高血压（RHTN）是一种临床复杂的病症，对健康有深远影响，需要大量的时间和医疗资源来进行有效的管理。揭示与 RHTN 相关的环境风险因素可能有助于发现未来降低其发病率的干预靶点。接触重金属已被证明与高血压风险增加有关，而与 RHTN 的关系仍知之甚少。
本研究使用 1999-2018 年全国健康与营养调查（NHANES）的数据，采用多变量逻辑回归模型，研究血液铅（Pb）、镉（Cd）和汞（Hg）与 RHTN 的关联。采用加权分位数总和（WQS）分析评估金属的综合效应和每种金属的贡献。
共纳入 38281 名参与者。与无耐药性高血压（NRHTN）相比，血液 Pb 浓度每增加 1μg/dL，RHTN 的比例增加 16%[调整后的优势比（aOR），1.16；95%置信区间（CI）1.01-1.32]。按四分位数（Q）分析，Pd 的 aOR[95%CI]为 1.30[1.01,1.67]（Q4 与 Q1 相比）；存在显著的剂量反应关系（p<0.05）。同样，作为连续变量，血液 Cd 水平每增加 1μg/dL，RHTN 的比例增加 13%（aOR：1.13；95%CI：[1.00,1.27]）；按四分位数分析，Cd 的 aOR[95%CI]为 1.30[1.01,1.69]（Q3 与 Q1 相比）和 1.35[1.03,1.75]（Q4 与 Q1 相比）；剂量反应关系具有统计学意义（p<0.05）。WQS 分析显示 Pb、Cd 和 Hg 对 RHTN 具有显著的综合效应，其中 Pb 的权重最高（0.64），其次是 Cd（0.25）和 Hg（0.11）。分层分析表明，这两种重金属与男性、<60 岁和肾功能障碍的参与者之间存在显著关联。
本研究基于全国数据提供了新的证据，表明环境重金属暴露在 RHTN 中的作用。旨在减少重金属暴露的预防策略应特别针对中年、男性和患有肾功能障碍的美国人。
