Vascular risk group, Health Research Institute of the San Carlos Clinical Hospital (IdISSC), Madrid, Spain; Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain; Hypertension and Vascular Risk Unit, Internal Medicine Service, San Carlos Clinical Hospital, Madrid, Spain.
Vascular risk group, Health Research Institute of the San Carlos Clinical Hospital (IdISSC), Madrid, Spain; Hypertension and Vascular Risk Unit, Internal Medicine Service, San Carlos Clinical Hospital, Madrid, Spain; Faculty of Medicine, Complutense University of Madrid (UCM), Madrid, Spain.
J Trace Elem Med Biol. 2024 Jul;84:127417. doi: 10.1016/j.jtemb.2024.127417. Epub 2024 Feb 28.
Lead (Pb), cadmium (Cd) and mercury (Hg) are toxic trace elements that represent a public health problem as risk factors for cardiovascular disease and hypertension (HT) and could also contribute to the development of resistant hypertension (rHT) AIMS: To compare the blood concentrations of Pb, Cd and Hg in subjects with resistant and non-resistant HT and to define whether there is a relationship between its levels and rHT.
Cross-sectional study. Subjects aged ≥ 21 to ≤ 80 years with a body mass index < 40 kg/m2 were recruited on a discretionary basis from October 2001 to October 2004 in a hypertension unit of a tertiary hospital amongst those sent to the hypertension unit by their family physician. Resistant hypertension was defined according to the American Heart Association (AHA) criteria. Whole blood concentrations of Cd, Pb and Hg were measured by electrothermal atomic absorption spectrometry.
46 out of 73 included subjects (63%) suffered from rHT. Blood Pb median: HT 3.9 (IQR 2.7-5.2) vs. rHT 3.6 (IQR 2.8-6.0) µg/dL (p=0.941). Blood Cd median: HT 0.07 (IQR 0.07-0.80) vs. rHT 0.30 (IQR 0.07-0.65) µg/L (p=0.681). Blood Hg median: HT 7.9 (IQR 5.8-12.9) vs. rHT 7.3 (IQR 4.6-13.3) µg/L (p=0.611). Considering the 75th percentile of each element (Pb: 5.55 µg/dL, Cd: 0.75 µg/L, Hg: 13.15 µg/L), a multiple logistic regression analysis (adjusted for age, BMI, diabetes mellitus, clearance of creatinine and only for Cd the smoking habit) showed an OR = 3.44 (0.84-14.10, p=0.086) for Pb, OR = 1.80 (0.39-8.24, p=0.451), for Cd and OR = 2.31 (0.59-9.14, p=0.232) for Hg. Moreover, the stratified analyses showed that men with Pb ≥5.55 µg/dL have a 14 times higher risk of suffering from rHT (p=0.026). Interestingly, a 9-fold increased risk was found for non-obese subjects with elevated Pb levels, above 5.55 µg/dL (p=0.029). Also in men, the probability of suffering from rHT was more than 7 times higher if Cd levels were ≥ 0.75 µg/L (p=0.076). Most smokers had higher Cd levels, with a high risk of suffering from rHT (ORa 12.6 (0.8-200.2), p=0.072).
A higher blood Pb levels, defined by the 75th percentile (Pb ≥ 5.55 µg/dL), is associated with a greater risk of suffering from rHT and to a lesser extent in the case of Cd and Hg.
铅（Pb）、镉（Cd）和汞（Hg）是有毒的微量元素，它们是心血管疾病和高血压（HT）的风险因素，也可能导致耐药性高血压（rHT）。目的：比较耐药性和非耐药性 HT 患者的血铅、镉和汞浓度，并确定其水平与 rHT 是否存在关系。方法：这是一项横断面研究。2001 年 10 月至 2004 年 10 月期间，在一家三级医院的高血压科，按照美国心脏协会（AHA）的标准，对从家庭医生转来的高血压患者进行了随机抽样。入选标准为年龄≥21 岁且≤80 岁，BMI＜40kg/m2。耐药性高血压的定义为血铅中位数：HT 3.9（IQR 2.7-5.2）与 rHT 3.6（IQR 2.8-6.0）µg/dL（p=0.941）。血镉中位数：HT 0.07（IQR 0.07-0.80）与 rHT 0.30（IQR 0.07-0.65）µg/L（p=0.681）。血汞中位数：HT 7.9（IQR 5.8-12.9）与 rHT 7.3（IQR 4.6-13.3）µg/L（p=0.611）。考虑到每个元素的第 75 个百分位数（Pb：5.55µg/dL，Cd：0.75µg/L，Hg：13.15µg/L），多元逻辑回归分析（调整年龄、BMI、糖尿病、肌酐清除率，仅针对 Cd 调整吸烟习惯）显示，Pb 的 OR = 3.44（0.84-14.10，p=0.086），Cd 的 OR = 1.80（0.39-8.24，p=0.451），Hg 的 OR = 2.31（0.59-9.14，p=0.232）。此外，分层分析显示，血 Pb 水平≥5.55µg/dL 的男性发生 rHT 的风险高 14 倍（p=0.026）。有趣的是，非肥胖者血 Pb 水平高于 5.55µg/dL 时，发生 rHT 的风险增加 9 倍（p=0.029）。此外，男性血 Cd 水平≥0.75µg/L 时，发生 rHT 的概率增加 7 倍以上（p=0.076）。大多数吸烟者血 Cd 水平较高，发生 rHT 的风险较高（ORa 12.6（0.8-200.2），p=0.072）。结论：较高的血 Pb 水平（定义为第 75 个百分位数（Pb≥5.55µg/dL））与发生 rHT 的风险增加相关，而 Cd 和 Hg 的相关性则较小。
