Abstract-Chronic lead exposure has been associated with elevated blood pressure in epidemiological studies. It is not known whether the previously observed relation between blood lead and hypertension persists after significant reductions have been made in environmental lead contamination. We examined the relation between blood lead levels and blood pressure in a representative sample of 14 952 whites and blacks aged 18 years or older who participated in the Third National Health and Nutrition Examination Survey. Blood lead was measured by atomic absorption spectrophotometry and blood pressure by standard sphygmomanometry. Mean blood lead levels were significantly higher for black men and women (5.4 and 3.4 g/dL, respectively) compared with white men and women (4.4 and 3.0 g/dL, respectively). Key Words: blood pressure Ⅲ ethnic groups Ⅲ blood lead Ⅲ blacks Ⅲ epidemiology M ost, 1-10 but not all, 11-16 studies have indicated that environmental exposure to lead is associated with an increased risk of hypertension and renal disease. A strong association between blood lead level and prevalence of hypertension was noted in the Second National Health and Nutrition Examination Survey (NHANES II). 4,17,18 The NHANES II was conducted during 1976 and 1980, when many of the current environmental measures, such as reduction in use of leaded gasoline, had not been adopted or had not been in place long enough to have a measurable effect on lead pollution. [17][18][19] In recent years, a strong secular trend toward decreasing blood lead concentrations has been noted in the general population. For example, among the US population aged 1 to 74 years, mean blood lead concentrations dropped by 78%, from 12.8 g/dL to 2.8 g/dL between 1976 to 1980 (NHANES II) and 1988 to 1991 (the first phase of the Third National Health and Nutrition Examination Survey [NHANES III]). 8,19 -21 Whether the relation between blood lead level and blood pressure (BP) is still present after this marked decline in environmental lead exposure is unknown. The present study examined the relation between blood lead level and BP in a large representative sample of blacks and whites who participated in NHANES III.
Methods
Study ParticipantsThe NHANES III was conducted by the National Center for Health Statistics between 1988 and 1994. Details of the NHANES III study participants and methods have been published elsewhere. 22 In brief, a stratified multistage probability design was used to obtain a representative sample of the civilian noninstitutionalized US general population. To improve the precision of estimates in certain subgroups, the design included oversampling of the very young, the elderly, blacks, and Mexican-Americans. A total of 19 618 participants 18 years of age and older were included in NHANES III. Participants were excluded from the current analysis when their self-reported race was not white or black (nϭ635) or when data on blood lead (nϭ3936) or BP (nϭ95) were missing. A total of 10 548 whites and 4404 blacks were included in the main analysi...