Perfluoroalkyl Substances Are Associated With Elevated Blood Pressure and Hypertension in Highly Exposed Young Adults

Abstract

Background Residents 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 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. Methods The study included 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. Hypertension was defined as any self-reported diagnosis, use of antihypertensive drugs, or elevated systolic blood pressure (SBP)/diastolic blood pressure (DBP). Generalized additive models were used to investigate the relation between each PFAS (perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), perfluorohexane sulfonic acid (PFHxS), and perfluorononanoic acid (PFNA)) ln transformed and by decile, and SBP, DBP, hypertension, adjusted for potential confounders. Results Both 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 DBP in women. One unit increase in each natural log 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). Conclusions Our findings suggest that serum PFAS concentrations were associated with moderately 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 clinical significance since even small increases in blood pressure levels at population level may be associated to a raised risk of adverse outcomes such as cardiovascular disease and target organ damage.