Perfluoroalkyl substances are associated with elevated blood pressure and hypertension in highly exposed young adults

Abstract

BackgroundResidents in a large area of North-Eastern Italy were exposed to perfluoroalkyl substances (PFAS) via drinking water. Studies on the association between PFAS and blood pressure levels are limited, and results are inconsistent. Using cross-sectional data from the Regional health surveillance program, we aimed to quantify the associations between PFAS serum concentrations and blood pressure and hypertension prevalence.MethodsThe study comprised 16,224 individuals aged 20-39 years. Pregnant women (n=327), or individuals with missing information on the selected covariates (n=111) were excluded, leaving 15,786 subjects for the analyses. Hypertension was defined as any self-reported diagnosis, use of antihypertensive drugs, or elevated systolic blood pressure (SBP≥140 mmHg)/diastolic blood pressure (DBP≥90 mmHg). Generalized additive models were used to investigate the relation between perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), perfluorohexane sulfonic acid (PFHxS), and perfluorononanoic acid (PFNA)) natural log (ln) transformed and by decile, and SBP, DBP, hypertension, adjusted for potential confounders.ResultsBoth SBP and DBP increased significantly with an increase in the ln-transformed serum PFAS concentrations in a monotonic way. The predicted increase in SBP and DBP were 1.54 mmHg (95%CI 0.61-2.47), 1.60 mmHg (95%CI 0.92-2.27) from lowest to highest decile of PFOA. The associations were stronger for SBP in men and for DBP in women. One unit increase in each In-transformed PFAS was positively associated with an increased odd of hypertension in men: PFOA OR=1.06 (1.01-1.11), PFOS OR=1.13 (1.03-1.23), PFHxS OR=1.08 (1.02-1.15), PFNA OR=1.20 (1.02-1.40).ConclusionsOur findings suggest that serum PFAS concentrations were associated with increased systolic and diastolic blood pressure in a large highly exposed young adult population. Although the magnitude of the observed effect was relatively small, if confirmed it would be of public health relevance since even small increases in blood pressure levels at the population level may be associated to a raised risk of adverse outcomes such as cardiovascular disease and target organ damage.

Perfluoroalkyl Substances and Abdominal Aortic Calcification

“…Fewer studies address PFAS and hypertension, which is a stronger risk factor for atherosclerotic disease. Recent cross-sectional work in NHANES-enrolled adolescents, and in a separate young adult prediabetics with substantial PFAS exposure, suggest a possible relationship of PFAS to this atherosclerotic risk factor as well 12,44,45 . Our results do not support a current addition of AAC to the list of associated risk factors.…”

“…Recent cross-sectional work in NHANES-enrolled adolescents, and in a separate young adult prediabetics with substantial PFAS exposure, suggest a possible relationship of PFAS to this atherosclerotic risk factor as well. 12,44,45 Our results do not support a current addition of AAC to the list of associated risk factors. The presence of a weak, non-significant association in a planned gender comparison opens the question of whether an association would be seen in a larger sample size.…”

Per- and Polyfluoroalkyl Substances and Incident Hypertension in Multi-Racial/Ethnic Women: The Study of Women's Health Across the Nation

“…28 Similarly, in a cross-sectional study of 16 224 adults aged 20 to 39 years living in Italy who were exposed to PFAS-contaminated drinking water, PFOA was associated with higher SBP in men and DBP in women; however, significant associations of PFOA, PFOS, PFHxS, and perfluorononanoate with prevalent hypertension were observed only in men. 29 Other cross-sectional studies reported no associations of PFAS with prevalent hypertension and blood pressure, 30–32 whereas one cross-sectional study of 154 male anglers aged 50 years and older in Wisconsin 30 found an inverse association between perfluorononanoate and prevalent hypertension. All these studies considered similar sets of confounders, including demographic factors, socioeconomic status, and lifestyle factors in their analyses.…”

“…Three cross-sectional studies reported significant positive associations of specific PFAS with prevalent hypertension and elevated blood pressure. 27–29 In a study of 2934 adults who participated in the 2003 to 2004 and 2005 to 2006 National Health and Nutrition Examination Survey, the adjusted odds for prevalent hypertension were 2 and a half-fold higher in those at the 80th versus the 20th percentiles of PFOA concentrations; no relationship was found for other PFAS. 27 A cross-sectional study of 1612 Chinese adults aged 22 to 96 years reported significant relationships of prevalent hypertension with PFOS, PFOA, perfluorononanoate, and perfluorobutanoate, with more pronounced effects observed in females; whereas no associations were detected for other compounds.…”

“…25 Until recently, only one study has investigated the associations between PFAS exposure and incident hypertension, 26 with no relationship detected in a prospective cohort of 660 prediabetic and overweight adults. Three cross-sectional studies have linked certain PFAS to increased prevalence of hypertension and elevated blood pressure, 27–29 but 3 separate studies reported no association or even suggested protective effects of PFAS. 30–32…”