Staessen J A, Bulpitt C J, Fagard R, Lauwerys R R, Roels H, Thijs L, Amery A
Department of Molecular and Cardiovascular Research, Katholieke Universiteit Leuven, Belgium.
J Cardiovasc Risk. 1994 Jun;1(1):87-97.
Several reports on the possible association between low-level lead exposure and blood pressure reflect diverging views. This meta-analysis aimed to find a common denominator in the published literature and to estimate whether a relationship exists between blood pressure and levels of lead in the blood.
Of the studies reviewed, 23 provided sufficient details to be considered. The meta-analysis included 33 groups with a total of 33 141 subjects, who had been recruited from the general population in 13 surveys and from occupational groups in 10 studies. In all but four studies the results were adjusted for age, and most studies took into account additional confounding factors.
The association between blood pressure and blood lead was similar in both men and women. In the combined studies, a twofold increase in blood lead concentration was associated with a 1.0 mmHg rise in systolic pressure (confidence interval 0.4-1.6 mmHg; P = 0.002) and with a 0.6 mmHg increase in diastolic pressure (confidence interval 0.2-1.0 mmHg; P = 0.02). The association with systolic pressure strongly relied on the inclusion of a large study (n = 3851) in which women's blood pressure was measured at the end of pregnancy. The association with diastolic pressure was largely due to a population survey in the USA (n = 6289). There was no relationship across studies between the strength of the blood pressure-blood lead relationship and the mean blood lead concentration.
The published evidence suggests that there can only be a weak positive association between blood pressure and lead exposure. Any such relationship may not be causal and is unlikely to entail any public-health implication in terms of hypertension-related complications. Nevertheless, these assumptions need to be confirmed in prospective population studies.
关于低水平铅暴露与血压之间可能存在的关联，已有多篇报道，但观点不一。本荟萃分析旨在在已发表的文献中找到一个共同的标准，并评估血压与血铅水平之间是否存在关联。
在回顾的研究中，有23项提供了足够的细节以供考虑。该荟萃分析纳入了33组，共33141名受试者，他们来自13项调查中的普通人群和10项研究中的职业群体。除了四项研究外，所有研究结果均根据年龄进行了调整，大多数研究还考虑了其他混杂因素。
血压与血铅之间的关联在男性和女性中相似。在综合研究中，血铅浓度增加两倍与收缩压升高1.0 mmHg相关（置信区间0.4 - 1.6 mmHg；P = 0.002），与舒张压升高0.6 mmHg相关（置信区间0.2 - 1.0 mmHg；P = 0.02）。与收缩压的关联很大程度上依赖于一项大型研究（n = 3851）的纳入，该研究在妊娠末期测量了女性的血压。与舒张压的关联主要归因于美国的一项人群调查（n = 6289）。在各项研究中，血压与血铅关系的强度与平均血铅浓度之间没有关系。
已发表的证据表明，血压与铅暴露之间可能仅存在微弱的正相关。任何此类关系可能并非因果关系，就高血压相关并发症而言，不太可能产生任何公共卫生影响。然而，这些假设需要在前瞻性人群研究中得到证实。
