Stress as a potential modifier of the impact of lead levels on blood pressure: the normative aging study.
BACKGROUND
Lead exposure and psychological stress have been independently associated with hypertension in various populations, and animal studies suggest that when they co-occur, their effects may be exacerbated.


OBJECTIVE
We examined whether psychological stress modifies the impact of cumulative lead exposure (measured as bone lead levels) on hypertension and blood pressure in Boston-area community-exposed men participating in the Normative Aging Study.


METHODS
We evaluated the modifying effect of stress on lead exposure on baseline hypertension status (513 participants) and on blood pressure in those without hypertension (237 participants), cross-sectionally. In baseline nonhypertensives, we examined the same risk factors in relation to prospective risk of developing hypertension.


RESULTS
Cross-sectional analysis revealed a positive interaction between stress and tibia lead on systolic blood pressure, after adjusting for age, body mass index, family history of high blood pressure, education, smoking, alcohol consumption, physical activity, and nutritional factors. In prospective multivariate analyses, high stress also modified the effect of tibia lead and patella lead on the risk of developing hypertension. Those reporting high stress had 2.66 [95% confidence interval (CI), 1.43-4.95] times the risk of developing hypertension per standard deviation increase in tibia lead and had 2.64 (95% CI, 1.42-4.92) times the risk per standard deviation increase in patella lead.


CONCLUSIONS
To our knowledge, these are the first analyses to look at interactive effects of stress and lead on hypertension in humans. These results suggest that the effect of lead on hypertension is most pronounced among highly stressed individuals, independent of demographic and behavioral risk factors.
Department of Environmental Health, Harvard Shool of Public Health, Boston, MA 02215, USA. jpeters@hsph.harvard.edu
Junenette L
JL
Peters
Laura
L
Kubzansky
Eileen
E
McNeely
Joel
J
Schwartz
Avron
A
Spiro
David
D
Sparrow
Robert O
RO
Wright
Huiling
H
Nie
Howard
H
Hu
D000375:Aging / Q000378:metabolism; D001794:Blood Pressure; D001900:Boston / Q000453:epidemiology; D004781:Environmental Exposure / Q000009:adverse effects; D004785:Environmental Pollutants / Q000032:analysis* / Q000633:toxicity; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000209:etiology* / Q000378:metabolism; D007854:Lead / Q000032:analysis* / Q000633:toxicity; D008297:Male; D010329:Patella / Q000737:chemistry*; D013315:Stress, Psychological / Q000150:complications*; D013977:Tibia / Q000737:chemistry*
D004785:Environmental Pollutants; D007854:Lead