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Published on: July 3, 2013

Contribution of lead to hypertension with renal impairment

V Batuman, E Landy, J K Maesaka

    The New England Journal of Medicine
    |July 7, 1983
    PubMed

    Insights

    Elevated lead levels, identified by the EDTA lead-mobilization test, were found in men with essential hypertension and reduced kidney function. This suggests lead exposure may contribute to hypertension-related renal disease.

    Area of Science:

    • Environmental Health
    • Nephrology
    • Cardiovascular Disease

    Background:

    • Essential hypertension, a common condition, has an unknown cause.
    • Lead poisoning is a potential, though often overlooked, cause of hypertension.
    • The EDTA lead-mobilization test effectively measures cumulative lead absorption.

    Purpose of the Study:

    • To investigate the association between cumulative lead absorption and essential hypertension.
    • To determine if lead exposure plays a role in hypertension-related renal impairment.

    Main Methods:

    • Utilized the EDTA lead-mobilization test to assess lead body stores in 48 men with essential hypertension.
    • Compared lead excretion in hypertensive patients with and without reduced renal function.
    • Included a control group of 22 patients with renal impairment from other causes.

    Main Results:

    • Hypertensive patients with reduced renal function (serum creatinine >1.5 mg/dL) showed significantly higher mobilizable lead levels.
    • Lead excretion in hypertensive patients was significantly greater than in control patients with similar renal impairment.
    • These findings were not attributable to renal disease alone.

    Conclusions:

    • Cumulative lead absorption may be an etiologic factor in "essential" hypertension, particularly in cases with renal compromise.
    • The EDTA test can identify patients with elevated lead burdens contributing to their hypertension.
    • Re-evaluating the etiology of essential hypertension to include lead exposure is warranted.

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