Endocrine-Disrupting Chemicals and Hypertension: Mechanisms and Clinical Implications

Hypertension remains one of the leading causes of global morbidity and mortality and is the leading modifiable risk factor for cardiovascular disease worldwide. The inability of conventional risk factors alone to fully explain the global prevalence of hypertension, together with accumulating evidence implicating endocrine-disrupting chemicals (EDCs) in the pathogenesis of hypertension, has led to growing scientific interest in this field over recent years. EDCs are exogenous environmental chemicals capable of disrupting hormone synthesis, transport, metabolism, and signaling pathways, thereby adversely affecting vascular and metabolic homeostasis. In particular, per- and polyfluoroalkyl substances (PFASs), bisphenol A, phthalates, PCBs, heavy metals, and pesticides have been associated with hypertension and may influence blood pressure regulation through multiple interconnected mechanisms, including oxidative stress, endothelial dysfunction, inflammation, epigenetic modifications, and activation of the renin-angiotensin-aldosterone system. Moreover, prenatal exposure to EDCs has been associated with hypertensive disorders of pregnancy, including gestational hypertension and preeclampsia, with potential implications for long-term maternal cardiovascular health. This review provides a comprehensive overview of the experimental and epidemiological evidence linking endocrine-disrupting chemicals to hypertension, with particular emphasis on the underlying molecular mechanisms, emerging clinical evidence, and future research directions.