title: Bone lead levels and blood pressure endpoints: a meta-analysis.
abstract: BACKGROUND
  Previous reviews have shown increases in blood pressure and hypertension associated with increases in lead levels in blood. We performed a meta-analysis of the association of bone lead levels with systolic blood pressure, diastolic blood pressure, and hypertension using published data.
  
  
  METHODS
  We searched Medline, Embase, and Toxline for epidemiologic studies on bone lead levels and blood pressure endpoints. We used inverse-variance weighted random-effects models to summarize the association of tibia or patella lead levels with blood pressure endpoints.
  
  
  RESULTS
  We summarized data from 3 prospective studies and 5 cross-sectional studies. All studies measured lead levels in tibia bone and 3 studies measured lead levels in patella. For a 10 microg/g increase in tibia lead, the cross-sectional summary increases in blood pressure were 0.26 mm Hg for systolic (95% confidence interval = 0.02 to 0.50) and 0.02 mm Hg for diastolic (-0.15 to 0.19). The summary odds ratio for hypertension was 1.04 (1.01 to 1.07). For a 10 microg/g increase in patella lead, the summary odds ratio for hypertension was 1.04 (0.96 to 1.12).
  
  
  CONCLUSIONS
  Systolic blood pressure and hypertension risk were associated with lead levels in tibia bone, but the magnitude of the summary estimates was small. These summary estimates, however, were based on published data and we could not evaluate nonlinear dose-response relationships, the relative contribution of bone and blood lead levels, or the influence of differences in study populations. A more detailed characterization of the association of bone lead levels and blood pressure endpoints would require a pooled analysis of individual participant data from existing studies.
authors.affiliation: Department of Environmental Health Sciences, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD 21205, USA. anavas@jhsph.edu
authors.forename: Ana
authors.initials: A
authors.lastname: Navas-Acien
authors.forename: Brian S
authors.initials: BS
authors.lastname: Schwartz
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Rothenberg
authors.forename: Howard
authors.initials: H
authors.lastname: Hu
authors.forename: Ellen K
authors.initials: EK
authors.lastname: Silbergeld
authors.forename: Eliseo
authors.initials: E
authors.lastname: Guallar
mesh_terms: D015415:Biomarkers / Q000032:analysis; D001794:Blood Pressure; D006801:Humans; D006973:Hypertension / Q000209:etiology*; D007854:Lead / Q000032:analysis* / Q000633:toxicity; D010329:Patella / Q000737:chemistry*; D013977:Tibia / Q000737:chemistry*
chemical_list: D015415:Biomarkers; D007854:Lead