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American Journal of Epidemiology Advance Access published online on January 18, 2006
American Journal of Epidemiology, doi:10.1093/aje/kwj060
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American Journal of Epidemiology Copyright © 2006 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A.
Received August 23, 2005
Accepted October 11, 2005

ORIGINAL CONTRIBUTIONS

Association of Blood Lead and Tibia Lead with Blood Pressure and Hypertension in a Community Sample of Older Adults

David Martin 1, Thomas A. Glass 2, Karen Bandeen-Roche 3, Andrew C. Todd 4, Weiping Shi 5, and Brian S. Schwartz 6 *

1 Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
2 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
3 Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
4 Department of Community and Preventive Medicine, Mount Sinai School of Medicine, New York, NY
5 Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
6 Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

* To whom correspondence should be addressed.
Brian S. Schwartz, E-mail: bschwart{at}jhsph.edu


  Abstract

Few studies have compared associations of blood lead and tibia lead with blood pressure and hypertension, and associations have differed in samples with occupational exposure compared with those with mainly environmental lead exposure. African Americans have been underrepresented in prior studies. The authors performed a cross-sectional analysis of 2001-2002 data from a community-based cohort in Baltimore, Maryland, of 964 men and women aged 50-70 years (40% African American, 55% White, 5% other race/ethnicity) to evaluate associations of blood lead and tibia lead with systolic and diastolic blood pressure and hypertension while adjusting for a large set of potential confounding variables. Blood lead was a strong and consistent predictor of both systolic and diastolic blood pressure in models adjusted and not adjusted for race/ethnicity and socioeconomic status. Tibia lead was associated with hypertension status before adjustment for race/ethnicity and socioeconomic status (p = 0.01); after such adjustment, the association was borderline significant (p = 0.09). Propensity score analysis suggested that standard regression analysis may have exaggerated the attenuation. These findings are discussed in the context of complex causal pathways. The data suggest that lead has an acute effect on blood pressure via recent dose and a chronic effect on hypertension risk via cumulative dose.

Keywords: blood pressure; body burden; fluorescence; hypertension; lead; social class; spectrometry, X-ray emission; tibia.
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