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. 2022 Jan;79(1):283-290.
doi: 10.1161/HYPERTENSIONAHA.121.18250. Epub 2021 Nov 17.

High Lead Exposure Associated With Higher Blood Pressure in Haiti: a Warning Sign for Low-Income Countries

Lily D Yan  1   2 , Vanessa Rouzier  2   3 , Jean Lookens Pierre  1   3 , Myung Hee Lee  1 , Paul Muntner  4 , Patrick J Parsons  5   6 , Alexandra Apollon  3 , Stephano St-Preux  3 , Rodolphe Malebranche  7   8 , Gerard Pierre  7 , Evens Emmanuel  1   9 , Denis Nash  10 , Justin Kingery  1   2 , Kathleen F Walsh  1   2 , Caleigh E Smith  1   2   11 , Miranda Metz  2 , Olga Tymejczyk  10 , Marie Deschamps  3 , Jean W Pape  2   3 , Daniel W Fitzgerald  2 , Margaret L McNairy  1   2
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High Lead Exposure Associated With Higher Blood Pressure in Haiti: a Warning Sign for Low-Income Countries

Lily D Yan et al. Hypertension. 2022 Jan.

Abstract

Cardiovascular disease is the leading cause of death in lower-income countries including Haiti. Environmental lead exposure is associated with high blood pressure and cardiovascular mortality in high-income countries but has not been systematically measured and evaluated as a potential modifiable cardiovascular risk factor in lower-income countries where 6.5 billion people reside. We hypothesized lead exposure is high in urban Haiti and associated with higher blood pressure levels. Blood lead levels were measured in 2504 participants ≥18 years enrolled in a longitudinal population-based cohort study in Port-au-Prince. Lead screening was conducted using LeadCare II (detection limit ≥3.3 µg/dL). Levels below detection were imputed by dividing the level of detection by √2. Associations between lead (quartiles) and systolic blood pressure and diastolic blood pressure were assessed, adjusting for age, sex, obesity, smoking, alcohol, physical activity, income, and antihypertensive medication use. The median age of participants was 40 years and 60.1% were female. The geometric mean blood lead level was 4.73µg/dL, 71.1% had a detectable lead level and 42.3% had a blood lead level ≥5 µg/dL. After multivariable adjustment, lead levels in quartile four (≥6.5 µg/dL) compared with quartile 1 (<3.4 µg/dL) were associated with 2.42 mm Hg (95% CI, 0.36-4.49) higher systolic blood pressure and 1.96 mm Hg (95% CI, 0.56-3.37) higher diastolic blood pressure. In conclusion, widespread environmental lead exposure is evident in urban Haiti, with higher lead levels associated with higher systolic and diastolic blood pressure. Lead is a current and potentially modifiable pollutant in lower-income countries that warrants urgent public health remediation. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03892265.

Keywords: Caribbean region; Haiti; blood pressure; global health; lead.

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Figures

Figure 1:
Figure 1:. Blood lead levels among Haitian adults using a screening test.
Dotted line indicates limit of detection, <3.3 μg/dL. Values less than the limit were imputed to have a value of 3.3/√2 = 2.33 μg/dL. Values above 25 μg/dL were combined into one bin.
Figure 2:
Figure 2:. Geometric mean blood lead levels in Haiti (2021) versus the US NHANES cohorts (2010–2016).
Bar height is geometric mean blood lead levels in the total population, and stratified by males and females. On the left, USA data from NHANES 2009–2010, 2011–2012, 2013–2014, 2015–2016 are shown, obtained from the CDC . Haiti CVD Cohort data from 2021 is shown on the right. Error bars represent 95% confidence intervals.
Figure 3:
Figure 3:. Main effect sizes between blood lead levels and systolic blood pressure and diastolic blood pressure across multivariable regression models.
Multivariable models adjusted for age categories, sex, BMI, smoking status, alcohol, physical activity, income, and taking antihypertensive medication.
See this image and copyright information in PMC

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