Air Quality Criteria for Lead Volume II of II - (NEPIS)(EPA) - US ...

AX6-145
Table AX6-5.1 (cont’d). Effects of Lead on Blood Pressure and Hypertension
Reference, Study
Location, and
Period Study Description Pb Measurement Findings, Interpretation
United States (cont’d)
Vupputuri et al.
(2003)
U.S.-NHANES III
1988-1994
5188 white women, 2300 black
women, 5360 white men, and 2104
black men, aged 18 yrs and older.
Survey adjusted multiple linear and
logistic regression were used to assess
linear blood Pb effect on systolic and
diastolic blood pressure and
hypertension in race and sex stratified
models.
Arithmetic mean (SD)
blood Pb:
White women 3.0 µg/dL (7.2)
Black women 3.4 µg/dL (4.8)
White men 4.4 µg/dL (7.3)
Black men 5.4 µg/dL (9.3)
Multiple linear regression models were all adjusted for age, education, BMI, alcohol
consumption, leisure time physical activity, dietary sodium and potassium, and total
calories. Only black women and men showed significant linear Pb effects. Every
1 µg/dL increase in blood Pb was associated with an increase of 0.47 mm Hg (95%
CI: 0.14, 0.80) in systolic and 0.32 mm Hg (95% CI: 0.11, 0.54) diastolic blood
pressure in black women, and 0.25 mm Hg (95% CI: 0.06, 0.44) systolic and 0.19
mm Hg (95% CI: 0.02, 0.36) diastolic blood pressure in black men.
Odds of hypertension (systolic ∃140 mm Hg, diastolic ∃90 mm Hg, or taking
antihypertensive medication) significantly increased for every SD (3.3 µg/dL) of
blood Pb level in black women (OR = 1.39 [95% CI: 1.21, 1.61]), in white women
(OR = 1.32 [95% CI: 1.14, 1.52]), in black men (OR = 1.26 [95% CI: 0.99, 1.19]),
but not in white men.
Linear blood Pb terms are usually not appropriate in multiple linear regression models
of blood pressure. Furthermore, they reported their results in terms of change in 1 SD
unit of Pb. Linear SD of Pb is incorrect for log-normal distributions of blood Pb. No
model diagnostic tests reported. Discrepancy between Methods report of race-Pb and
sex-Pb interactions in simple, not multiple, analyses, but Results reports significant
interactions for race-Pb and sex-Pb in multiple regression models for both linear
regression and logistic regression models, without showing the results of the
interaction analyses. The probability of the stated interactions (p < 0.001) appears
extremely low, given the degree of 95% CI overlap in Pb coefficients among the
stratified models. No model diagnostics reported.