Urinary Arsenic, Lead, and Their Joint Effects on Hypotension in Children and Adolescents Aged 8–17 Years: A Cross Sectional Analysis of NHANES 2007–2018

Wen Duan; Jie Liu; Xinpei Luo; Caixia Liu; Zhui Ke

doi:10.62177/apjcmr.v2i2.1288

Authors

Wen Duan China Three Gorges University & Yichang Central People's Hospital
Jie Liu China Three Gorges University & Yichang Central People’s Hospital
Xinpei Luo The Tenth People’s Hospital
Caixia Liu Affiliated MinDa Hospital
Zhui Ke The Tenth People’s Hospital

DOI:

https://doi.org/10.62177/apjcmr.v2i2.1288

Keywords:

NHANES, Hypotension, Heavy Metals, Lead, Arsenic

Abstract

Background: Evidence on the joint effects of arsenic and lead exposure on pediatric hypotension is limited. The modifying roles of age, sex, and body weight in this association remain unclear. Methods: Using NHANES 2007-2018 data (2,043 adolescents aged 8-17y), we employed survey-weighted logistic regression (hypotension risk), weighted linear regression (blood pressure percentiles), and Weighted Quantile Sum regression (joint effects). Results: In weighted logistic regression, Model 1 (adjusted for age, sex, race) showed arsenic fourth quartile increased hypotension risk (OR=1.73, 95%CI:1.13 2.64, P=0.01). After full adjustment (Model 2: Model 1+ BMI, income, sodium, calories, household size), this risk remained significant (OR=1.63, 95%CI:1.03-2.5, P=0.04) with a significant trend (P-trend =0.04). For lead, Model I fourth quartile risk (OR=1.66, 95%CI:1.05-2.64, P=0.03) shifted to third quartile significance in Model 2 (OR=1.54, 95%CI:1.04-2.28, P=0.03). Linear regression revealed arsenic third quartile significantly reduced diastolic blood pressure percentile in both Model 1 (β=6.20, 95%CI:-10.92-1.47, P=0.01) and Model 2 (β=5.75, 95%CI:-10.41-1.09, P=0.02). The Weighted Quantile Sum (WQS) index showed consistent risk in the main model (OR=1.21, 95%CI:1.03-1.42, P=0.02). Stratified analyses (Model 2 based) showed males had higher lead sensitivity Q2 (OR = 2.01, P = 0.005), normal weight individuals had strongest associations lead Q4 (OR = 2.14, P = 0.02): arsenic Q4 (OR = 2.04, P = 0.02) and early puberty (11–13 years) exhibited peak lead risk Q3 (OR = 2.45, P = 0.005). Conclusion: Arsenic and lead additively increase pediatric hypotension risk, with effects modified by sex, BMI, and pubertal stage. Normal-weight males in early puberty are the most vulnerable subgroup.

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References

Yang, L., Magnussen, C. G., Yang, L., Bovet, P., & Xi, B. (2020). Elevated blood pressure in childhood or adolescence and cardiovascular outcomes in adulthood: A systematic review. Hypertension, 75(4), 948–955. https://doi.org/10.1161/HYPERTENSIONAHA.119.14168

Benjamin, E. J., Muntner, P., Alonso, A., et al. (2019). Heart disease and stroke statistics—2019 update: A report from the American Heart Association. Circulation, 139(10). https://doi.org/10.1161/CIR.0000000000000659

Cosselman, K. E., Navas-Acien, A., & Kaufman, J. D. (2015). Environmental factors in cardiovascular disease. Nature Reviews Cardiology, 12(11), 627–642. https://doi.org/10.1038/nrcardio.2015.152

Wu, X., Cobbina, S. J., Mao, G., Xu, H., Zhang, Z., & Yang, L. (2016). A review of toxicity and mechanisms of individual and mixtures of heavy metals in the environment. Environmental Science and Pollution Research, 23(9), 8244–8259. https://doi.org/10.1007/s11356-016-6333-x

Al Osman, M., Yang, F., & Massey, I. Y. (2019). Exposure routes and health effects of heavy metals on children. Biometals, 32(4), 563–573. https://doi.org/10.1007/s10534-019-00193-5

Zhao, J., Li, A., Mei, Y., et al. (2021). The association of arsenic exposure with hypertension and blood pressure: A systematic review and dose–response meta-analysis. Environmental Pollution, 289, 117914. https://doi.org/10.1016/j.envpol.2021.117914

Zachariah, J. P., Wang, Y., Penny, D. J., & Baranowski, T. (2018). Relation between lead exposure and trends in blood pressure in children. The American Journal of Cardiology, 122(11), 1890–1895. https://doi.org/10.1016/j.amjcard.2018.08.033

Qu, Y., Lv, Y., Ji, S., et al. (2022). Effect of exposures to mixtures of lead and various metals on hypertension, pre-hypertension, and blood pressure: A cross-sectional study from the China National Human Biomonitoring. Environmental Pollution, 299, 118864. https://doi.org/10.1016/j.envpol.2022.118864

Zeng, H., Wang, Q., Wang, H., et al. (2022). Exposure to barium and blood pressure in children and adolescents: results from the 2003–2018 National Health and Nutrition Examination Survey. Environmental Science and Pollution Research, 29(45), 68476–68487. https://doi.org/10.1007/s11356-022-20507-4

Yao, B., Lu, X., Xu, L., Wang, Y., Qu, H., & Zhou, H. (2020). Relationship between low-level lead, cadmium and mercury exposures and blood pressure in children and adolescents aged 8–17 years: An exposure-response analysis of NHANES 2007–2016. Science of The Total Environment, 726, 138446. https://doi.org/10.1016/j.scitotenv.2020.138446

Desai, G., Niu, Z., Luo, W., Frndak, S., Shaver, A. L., & Kordas, K. (2021). Low-level exposure to lead, mercury, arsenic, and cadmium, and blood pressure among 8-17-year-old participants of the 2009–2016 National Health and Nutrition Examination Survey. Environmental Research, 197, 111086. https://doi.org/10.1016/j.envres.2021.111086

Shan, Q. (2022). Trend analysis of the association of urinary metals and obesity in children and adolescents. Chemosphere, 307, 135617. https://doi.org/10.1016/j.chemosphere.2022.135617

Carrico, C., Gennings, C., Wheeler, D. C., & Factor-Litvak, P. (2015). Characterization of weighted quantile sum regression for highly correlated data in a risk analysis setting. JABES, 20(1), 100–120. https://doi.org/10.1007/s13253-014-0180-3

Guo, X., Li, N., Wang, H., et al. (2022). Combined exposure to multiple metals on cardiovascular disease in NHANES under five statistical models. Environmental Research, 215, 114435. https://doi.org/10.1016/j.envres.2022.114435

Haque, I. U., & Zaritsky, A. L. (2007). Analysis of the evidence for the lower limit of systolic and mean arterial pressure in children. Pediatric Critical Care Medicine, 8(2), 138–144. https://doi.org/10.1097/01.PCC.0000257039.32593.DC

Herman-Giddens, M. E., Slora, E. J., Wasserman, R. C., et al. (1997). Secondary sexual characteristics and menses in young girls seen in office practice: A study from the Pediatric Research in Office Settings Network. Pediatrics, 99(4), 505–512. https://doi.org/10.1542/peds.99.4.505

Ogden, C. L., Kuczmarski, R. J., Flegal, K. M., et al. (2002). Centers for Disease Control and Prevention 2000 Growth Charts for the United States: Improvements to the 1977 National Center for Health Statistics Version. Pediatrics, 109(1), 45–60. https://doi.org/10.1542/peds.109.1.45

Duan, W., Xu, C., Liu, Q., et al. (2020). Levels of a mixture of heavy metals in blood and urine and all-cause, cardiovascular disease and cancer mortality: A population-based cohort study. Environmental Pollution, 263, 114630. https://doi.org/10.1016/j.envpol.2020.114630

Abhyankar, L. N., Jones, M. R., Guallar, E., & Navas-Acien, A. (2012). Arsenic exposure and hypertension: A systematic review. Environmental Health Perspectives, 120(4), 494–500. https://doi.org/10.1289/ehp.1103988

Obeng-Gyasi, E. (2019). Lead exposure and cardiovascular disease among young and middle-aged adults. Medical Sciences, 7(11), 103. https://doi.org/10.3390/medsci7110103

Wojcik, M., Starzyk, J. B., Drodz, M., & Drodz, D. (2023). Effects of puberty on blood pressure trajectories — Underlying processes. Current Hypertension Reports, 25(7), 117–125. https://doi.org/10.1007/s11906-023-01241-9

Tanaka, H., Borres, M., Thulesius, O., Tamai, H., Ericson, M. O., & Lindblad, L. E. (2000). Blood pressure and cardiovascular autonomic function in healthy children and adolescents. The Journal of Pediatrics, 137(1), 63–67. https://doi.org/10.1067/mpd.2000.108098

Levin-Schwartz, Y., Politis, M., Gennings, C., et al. (2021). Nephrotoxic metal mixtures and preadolescent kidney function. Children, 8(8), 673. https://doi.org/10.3390/children8080673

Wroblewski, M., Milek, J., Godlewski, A., & Wroblewska, J. (2025). The impact of arsenic, cadmium, lead, mercury, and thallium exposure on the cardiovascular system and oxidative mechanisms in children. CIMB, 47(7), 483. https://doi.org/10.3390/cimb47070483

Perrelli, M., Wu, R., Liu, D. J., et al. (2022). Heavy metals as risk factors for human diseases – a Bayesian network approach. European Review for Medical and Pharmacological Sciences, 26(24), 9275–9310. https://doi.org/10.26355/eurrev_202212_30681

Gomez-Ambrosi, J., Silva, C., Galofre, J. C., et al. (2012). Body mass index classification misses subjects with increased cardiometabolic risk factors related to elevated adiposity. International Journal of Obesity, 36(2), 286–294. https://doi.org/10.1038/ijo.2011.100

Ouchi, N., Parker, J. L., Lugus, J. J., & Walsh, K. (2011). Adipokines in inflammation and metabolic disease. Nature Reviews Immunology, 11(2), 85–97. https://doi.org/10.1038/nri2921

Vaziri, N. D., & Sica, D. A. (2004). Lead-induced hypertension: Role of oxidative stress. Current Science Inc., 6(4), 314–320. https://doi.org/10.1007/s11906-004-0027-3

Vahter, M., Akesson, A., Liden, C., Ceccatelli, S., & Berglund, M. (2007). Gender differences in the disposition and toxicity of metals. Environmental Research, 104(1), 85–95. https://doi.org/10.1016/j.envres.2006.08.003

Barchowsky, A., Dudek, E. J., Treadwell, M. D., & Wetterhahn, K. E. (1996). Arsenic induces oxidant stress and NF-KB activation in cultured aortic endothelial cells. Free Radical Biology and Medicine, 21(6), 783–790. https://doi.org/10.1016/0891-5849(96)00174-8

Simons, T. J. B., & Pocock, G. (1987). Lead enters bovine adrenal medullary cells through calcium channels. Journal of Neurochemistry, 48(2), 383–389. https://doi.org/10.1111/j.1471-4159.1987.tb04105.x

Mumford, J. L., Wu, K., Xia, Y., et al. (2007). Chronic arsenic exposure and cardiac repolarization abnormalities with QT interval prolongation in a population-based study. Environmental Health Perspectives, 115(5), 690–694. https://doi.org/10.1289/ehp.9686