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Cited by 281Arsenic contamination and mitigationHeavy Metal Exposure and ToxicityBlood Pressure and Hypertension Studies

The DOI matches its Crossref record; 52 of the 53 references it cites were found in a registry or an index.

Arsenic Exposure and Hypertension: A Systematic Review

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Abhyankar, Lalita N., Jones, Miranda R., Guallar, Eliseo, Navas-Acien, Ana·2012·Environmental Health Perspectives
DOI 10.1289/ehp.1103988PMC PMC3339454
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Abstract

Background: Environmental exposure to arsenic has been linked to hypertension in persons living in arsenic-endemic areas. Objective: We summarized published epidemiologic studies concerning arsenic exposure and hypertension or blood pressure (BP) measurements to evaluate the potential relationship. Data sources and extraction: We searched PubMed, Embase, and TOXLINE and applied predetermined exclusion criteria. We identified 11 cross-sectional studies from which we abstracted or derived measures of association and calculated pooled odds ratios (ORs) using inverse-variance weighted random-effects models. Data synthesis: The pooled OR for hypertension comparing the highest and lowest arsenic exposure categories was 1.27 [95% confidence interval (CI): 1.09, 1.47; p-value for heterogeneity = 0.001; I2 = 70.2%]. In populations with moderate to high arsenic concentrations in drinking water, the pooled OR was 1.15 (95% CI: 0.96, 1.37; p-value for heterogeneity = 0.002; I2 = 76.6%) and 2.57 (95% CI: 1.56, 4.24; p-value for heterogeneity = 0.13; I2 = 46.6%) before and after excluding an influential study, respectively. The corresponding pooled OR in populations with low arsenic concentrations in drinking water was 1.56 (95% CI: 1.21, 2.01; p-value for heterogeneity = 0.27; I2 = 24.6%). A dose–response assessment including six studies with available data showed an increasing trend in the odds of hypertension with increasing arsenic exposure. Few studies have evaluated changes in systolic and diastolic BP (SBP and DBP, respectively) measurements by arsenic exposure levels, and those studies reported inconclusive findings. Conclusion: In this systematic review we identified an association between arsenic and the prevalence of hypertension. Interpreting a causal effect of environmental arsenic on hypertension is limited by the small number of studies, the presence of influential studies, and the absence of prospective evidence. Additional evidence is needed to evaluate the dose–response relationship between environmental arsenic exposure and hypertension.

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Crossref · 10.1289/ehp.1103988

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Figure 1 Summary of search and screening process. aA total of 138 studies were not in English. bChen Y et al. (2007) and Jones et al. (2011) were the only studies including both hypertension and BP level end points.
Figure 1 Summary of search and screening process. aA total of 138 studies were not in English. bChen Y et al. (2007) and Jones et al. (2011) were the only studies including both hypertension and BP level end points.CC0 · PubMed Central
Figure 2 ORs of hypertension by arsenic exposure levels. The area of each square is proportional to the inverse of the variance of the estimated log OR. Horizontal lines represent 95% CIs. In the Chen Y et al. (2007) study, arsenic concentrations in drinking water were estimated based on time-weighted arsenic concentrations (ΣCiTi /ΣTi, where “Ci and Ti denote the well arsenic concentration and drinking duration for the ith well”).
Figure 2 ORs of hypertension by arsenic exposure levels. The area of each square is proportional to the inverse of the variance of the estimated log OR. Horizontal lines represent 95% CIs. In the Chen Y et al. (2007) study, arsenic concentrations in drinking water were estimated based on time-weighted arsenic concentrations (ΣCiTi /ΣTi, where “Ci and Ti denote the well arsenic concentration and drinking duration for the ith well”).CC0 · PubMed Central
Figure 3 Evaluation of dose response for arsenic exposure and hypertension. Blue symbols indicate studies conducted in populations with low arsenic levels in drinking water (average < 50 μg/L); black symbols indicate studies conducted in populations with moderate-to-high arsenic levels in drinking water (average > 50 μg/L). The size of each data point is inversely weighted based on the inverse of the variance of the estimated log OR. For the Wang SL et al. (2007) study, actual arsenic levels for each hair tertile were not provided, and values defining the arsenic exposure tertiles were approximated based on the geometric mean of hair arsenic.
Figure 3 Evaluation of dose response for arsenic exposure and hypertension. Blue symbols indicate studies conducted in populations with low arsenic levels in drinking water (average < 50 μg/L); black symbols indicate studies conducted in populations with moderate-to-high arsenic levels in drinking water (average > 50 μg/L). The size of each data point is inversely weighted based on the inverse of the variance of the estimated log OR. For the Wang SL et al. (2007) study, actual arsenic levels for each hair tertile were not provided, and values defining the arsenic exposure tertiles were approximated based on the geometric mean of hair arsenic.CC0 · PubMed Central
Figure 4 Difference (95% CI) in mean SBP and DBP by arsenic exposure level. The area of each square is proportional to the inverse of the variance of the estimated. NA: not available [the study by Chen Y et al. (2007) did not include standard errors or data that would allow estimation of the standard errors for mean systolic and diastolic blood pressure SBP and DBP levels, and a 95% CI could not be calculated for this study]. aProfessions include taxidermists, garden fence makers, weekend cottage constructors, wood impregnators, electric pylon impregnators, and new house constructors (Jensen and Hansen 1998).
Figure 4 Difference (95% CI) in mean SBP and DBP by arsenic exposure level. The area of each square is proportional to the inverse of the variance of the estimated. NA: not available [the study by Chen Y et al. (2007) did not include standard errors or data that would allow estimation of the standard errors for mean systolic and diastolic blood pressure SBP and DBP levels, and a 95% CI could not be calculated for this study]. aProfessions include taxidermists, garden fence makers, weekend cottage constructors, wood impregnators, electric pylon impregnators, and new house constructors (Jensen and Hansen 1998).CC0 · PubMed Central

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Metadata

Authors
Abhyankar, L. N., Jones, M. R., Guallar, E., & Navas-Acien, A.
Affiliations
  • Johns Hopkins University (US)
  • Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  • Department of Environmental Health Sciences, and
ORCID
Jones, Miranda R.
Venue
Environmental Health Perspectives
Publisher
American Chemical Society (ACS)
Published
2011-12-02
Volume
120
Issue
4
Pages
494-500
ISSN
  • 0091-6765 (ISSN-L)
  • 1552-9924
DOI
10.1289/ehp.1103988
PMC
PMC3339454
OpenAlex
W1984271811
Cited by
281
References
53
Citations by year
2026: 11 · 2025: 12 · 2024: 22 · 2023: 5 · 2022: 25 · 2021: 31 · 2020: 28 · 2019: 17 · 2018: 18 · 2017: 22 · 2016: 22 · 2015: 24 · 2014: 25 · 2013: 17 · 2012: 2
FWCI
1.15
Type
journal article
Language
en
Open access
Licence
Locations
  • Environmental Health Perspectives (publishedVersion, public-domain)
  • Europe PMC (PubMed Central) (publishedVersion, public-domain)
  • PubMed Central (publishedVersion, public-domain)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (5r01hl090863-04)
  • National Heart, Lung, and Blood Institute (R01-HL-090863)
Topics
  • Physical Sciences › Environmental Science › Environmental Chemistry › Arsenic contamination and mitigation
  • Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Heavy Metal Exposure and Toxicity
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
Keywords
arsenic exposure, hypertension, blood pressure, drinking water arsenic, dose-response relationship, arsenic endemic areas, environmental arsenic, systolic blood pressure, diastolic blood pressure
MeSH terms
Arsenic, Blood Pressure, Dose-Response Relationship, Drug, Environmental Exposure, Humans, Hypertension, Prevalence, Drinking Water

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