title: Environmental lead exposure is associated with visit-to-visit systolic blood pressure variability in the US adults.
abstract: OBJECTIVE
  The association between environmental lead exposure and blood pressure variability, an important risk factor for cardiovascular disease, is unexplored and unknown. The objective of the study was to test the hypothesis that lead exposure is associated with blood pressure variability.
  
  
  METHODS
  American participants 17 years of age or older from National Health and Nutrition Examination Survey III were included in the analysis. Participants' blood lead concentrations expressed as micrograms per deciliter were determined. The standard deviations of visit-to-visit systolic and diastolic blood pressure were calculated to determine blood pressure variability. Multivariable regression analyses adjusted for age, gender, race, smoking and socioeconomic status were employed.
  
  
  RESULTS
  The participants' mean age and mean blood lead concentration were 42.72 years and 3.44 mcg/dl, respectively. Systolic blood pressure variability was significantly associated with environmental lead exposure after adjusting for the effect of the confounders. The unadjusted and adjusted means of visit-to-visit systolic blood pressure variability and the β coefficient of lead exposure were 3.44, 3.33 mcg/dl, β coefficient = 0.07, P < 0.01.
  
  
  CONCLUSIONS
  This study documents a positive linear relationship between environmental lead exposure and systolic blood pressure variability. Screening adults with fluctuating blood pressure for lead exposure could be warranted.
authors.affiliation: Department of Epidemiology, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, 77205, USA, melfaramawi@uams.edu.
authors.forename: Mohammed F
authors.initials: MF
authors.lastname: Faramawi
authors.forename: Robert
authors.initials: R
authors.lastname: Delongchamp
authors.forename: Yu-Sheng
authors.initials: YS
authors.lastname: Lin
authors.forename: Youcheng
authors.initials: Y
authors.lastname: Liu
authors.forename: Saly
authors.initials: S
authors.lastname: Abouelenien
authors.forename: Lori
authors.initials: L
authors.lastname: Fischbach
authors.forename: Supriya
authors.initials: S
authors.lastname: Jadhav
mesh_terms: D000293:Adolescent; D000328:Adult; D001794:Blood Pressure / Q000187:drug effects*; D004781:Environmental Exposure / Q000009:adverse effects* / Q000032:analysis*; D005260:Female; D006801:Humans; D007854:Lead / Q000097:blood*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D012044:Regression Analysis; D012307:Risk Factors; D014481:United States; D055815:Young Adult
chemical_list: D007854:Lead
references.citation: Indian J Med Res. 2007 Dec;126(6):518-27
references.pmid: 18219078
references.citation: Neurology. 2000 Oct 24;55(8):1144-50
references.pmid: 11071492
references.citation: Environ Health Perspect. 2007 Mar;115(3):463-71
references.pmid: 17431500
references.citation: Occup Environ Med. 2001 Feb;58(2):73-80
references.pmid: 11160984
references.citation: Environ Health Perspect. 1998 Nov;106(11):745-50
references.pmid: 9799191
references.citation: Nat Rev Cardiol. 2013 Mar;10(3):143-55
references.pmid: 23399972
references.citation: Hypertension. 2001 Feb;37(2):223-6
references.pmid: 11230275
references.citation: Am J Epidemiol. 2001 Jan 15;153(2):164-71
references.pmid: 11159162
references.citation: Epidemiology. 2002 May;13(3):311-9
references.pmid: 11964933
references.citation: JAMA. 2010 May 26;303(20):2043-50
references.pmid: 20501926
references.citation: Environ Health Perspect. 2007 Dec;115(12):1696-700
references.pmid: 18087585
references.citation: Circulation. 2011 Apr 12;123(14):1545-51
references.pmid: 21444885
references.citation: J Pak Med Assoc. 2009 Jun;59(6):350-4
references.pmid: 19534366
references.citation: Environ Res. 2006 Jul;101(3):380-6
references.pmid: 16360143
references.citation: J Hypertens Suppl. 2002 Jun;20(3):S15-20
references.pmid: 12184052
references.citation: Lancet. 2010 Mar 13;375(9718):895-905
references.pmid: 20226988
references.citation: MMWR Morb Mortal Wkly Rep. 1991 Mar 1;40(8):139-41
references.pmid: 1705309
references.citation: Curr Hypertens Rep. 2012 Aug;14(4):333-8
references.pmid: 22552574
references.citation: Hypertension. 2007 Dec;50(6):991-7
references.pmid: 17954719
references.citation: Arch Intern Med. 2005 Oct 10;165(18):2155-61
references.pmid: 16217007
references.citation: J Hum Hypertens. 2013 Oct;27(10):589-93
references.pmid: 23535987
references.citation: JAMA. 1996 Apr 17;275(15):1177-81
references.pmid: 8609685
references.citation: Environ Health Perspect. 1999 May;107 Suppl 2:349-55
references.pmid: 10350520
references.citation: Curr Opin Nephrol Hypertens. 2013 Jan;22(1):59-64
references.pmid: 23165110
references.citation: Brain Behav Immun. 2006 Sep;20(5):498-504
references.pmid: 16330181
references.citation: Hypertens Res. 2014 Sep;37(9):875-9
references.pmid: 24804612
references.citation: Hypertension. 1999 Oct;34(4 Pt 1):558-62
references.pmid: 10523326
references.citation: Vital Health Stat 1. 1994 Jul;(32):1-407
references.pmid: 7975354
references.citation: Lancet. 2010 Aug 7;376(9739):413; author reply 414-5
references.pmid: 20692521
references.citation: Hypertension. 2003 Mar;41(3):463-8
references.pmid: 12623944
references.citation: Hypertens Res. 2012 Jan;35(1):55-61
references.pmid: 21814215
references.citation: N Engl J Med. 1983 Jun 9;308(23):1373-7
references.pmid: 6188954
references.citation: Diabetes Care. 2013 Aug;36 Suppl 2:S312-24
references.pmid: 23882065
references.citation: Bull World Health Organ. 2000;78(9):1068-77
references.pmid: 11019456