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Relation Between Lead Exposure and Trends in Blood Pressure in Children
Justin P Zachariah1, Yunfei Wang1, Daniel J Penny1
1Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
Insights
Childhood obesity rose while blood pressure (BP) trends were mixed. Decreasing lead exposure significantly impacted BP, particularly mean arterial pressure, suggesting environmental factors influence cardiovascular health in youth.
Area of Science:
- Environmental Health
- Pediatric Cardiology
- Public Health Epidemiology
Background:
- Global obesity rates have surged, yet population blood pressure (BP) trends have remained unexpectedly flat or declined.
- Pediatric BP trends offer unique insights due to minimal confounding from antihypertensive therapies.
- Contrasting trends in large artery (pulse pressure) and small artery (mean arterial pressure) measures suggest complex underlying mechanisms.
Purpose of the Study:
- To investigate the association between decreasing pediatric lead exposure and concurrent temporal trends in blood pressure.
- To analyze how lead exposure may explain the divergence between rising obesity and population BP levels in children.
- To examine the impact of environmental factors on cardiovascular health indicators in pediatric populations.
Main Methods:
- Analysis of anthropometric, BP, and laboratory data from 13,501 children aged 8-17 years (National Health and Nutrition Examination Surveys, 1976-2008).
- Utilized multivariable adjusted survey regression to assess temporal BP trends in relation to blood lead concentrations.
- Decomposed BP into arterial measures (pulse pressure, mean arterial pressure) to identify specific vascular effects.
Main Results:
- Obesity prevalence increased from 5.3% to 24.5%, while systolic BP remained stable, and diastolic BP and mean arterial pressure (MAP) decreased significantly.
- Pulse pressure increased, indicating a rise in large artery measures, contrasting with the decline in small artery measures (MAP).
- Accounting for blood lead concentration attenuated the decreasing MAP trend by 67%, highlighting lead's significant role.
Conclusions:
- The observed paradoxical trends in pediatric BP during the rise in obesity are substantially explained by decreasing lead exposure.
- Reduced lead exposure appears to act on small resistance arteries, counteracting the expected BP-raising effects of obesity.
- Environmental policies reducing lead levels may yield substantial, long-lasting cardiovascular benefits for both youth and adults globally.
Abstract:
Obesity raises blood pressure (BP) in children and adults. Nevertheless, as obesity increased around the globe, population systolic and diastolic blood pressures were flat or fell. Examining children is insightful because pediatric trends are largely unconfounded by antihypertensive therapy. Decomposing BP into arterial types, large artery measures (pulse pressure) increased in concert with obesity while small artery measures (mean arterial pressure, [MAP]) decreased, suggesting small arteries are the locus of the countervailing temporal trends. Pediatric lead exposure decreased as pediatric obesity rose. Over the period of rising obesity, we examined the association between lead exposure and temporal trends in BP. We analyzed anthropometric, BP, and laboratory data on 8-17 year old children from the serial cross-sectional National Health and Nutrition Examination Surveys 1976 through 2008. Multivariable adjusted survey regression was used to examine temporal trends in blood pressure in relation to blood lead concentrations (N = 13,501). As obesity prevalence rose from 5.3% to 24.5%, age-sex adjusted systolic BP was flat (-0.01 [95% confidence interval (CI) -0.06, 0.04] mm Hg/yr, p = 0.8), diastolic BP and MAP decreased (respectively -0.28 [-0.32, -0.24] and -0.19 [CI -0.23, -0.15], both p<0.0001) while pulse pressure increased (0.28 [0.23, 0.32], p<0.001). Accounting for blood lead concentration attenuated the decreasing MAP trend by 67%. In conclusion, the contrary trends in pediatric BP during the rise of pediatric obesity may be substantially attributable to decreasing lead exposure acting on small resistance arteries. These results have implications for globally observed BP trends in youth and adults. Environmental policy altering lead levels may have long-lasting cardiovascular benefits.
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