Association Of PFAS Exposure With Hypertension A Cross-sectional Study Based On NHANES

Objective:Perfluoroalkyl and polyfluoroalkyl substances(PFAS)is a general term for a series of artificial compounds widely used in industrial products.There are studies have reported that exposure to PFAS will affect human health and hypertension through potential mechanisms,but the association between PFAS and hypertension remains controversial.We hope to study the effects of PFAS on hypertension by national health and nutrition survey(NHANES).Methods:In the NHANES database from 2013 to 2018,there were 6 kinds of PFAS selected for this study,which had valid data(numerical results higher than the detection limit)accounted for more than 70%,including Perfluorodecanoic acid(PFDe A),Perfluorohexane sulfonic acid(PFHx S),Perfluorononanoic acid(PFNA),n-Perfluorooctanoic acid(n-PFOA),n-Perfluorooctane sulfonic acid(n-PFOS)and Perfluoromethylheptane sulfonic acid isomers(Sm-PFOS).We included data from 4561 participants in the National Health and Nutrition Examination Survey between 2013 to2018 in this cross-sectional study,and collect participants’ basic information and laboratory biochemical test results.Single and multivariable logistic regression were adopted to assess the associations between PFAS and hypertension,subgroup analysis and interaction test analysis were used to verify the existence of effect modifiers.PFAS was expressed as continuous and quartile respectively to verify the stability of result.In order to verify the consistency of result in various situations,3 kinds of sensitivity analysis were carried out,including taking intp underage participants,restricted to adult participants who did not take antihypertensive drugs,and using 130/80 mm Hg to define hypertension.Moreover,spline smoothing plots and linear regression were used to assess the relationship between PFAS and blood pressure,include systolic and diastolic blood pressure.The data analyses were carried out using R and Empower Stats,the results were considered statistically significant with P < 0.05.Results:(1)After fully adjusting confounders,there was a positive correlation between PFDe A exposure and hypertension(OR=1.2,95% CI: 1.0-1.4,P=0.010).Other PFAS did not show a relationship between hypertensionn,and the results were PFHx S(OR=1.0,95%CI: 0.9-1.0,P=0.538),PFNA(OR=1.0,95%CI: 0.9-1.1,P=0.635)and n-PFOA(OR=1.0,95%CI:1.0-1.0,P=0.862)、n-PFOS(OR=1.0,95%CI:1.0-1.0,P=0.001)、Sm-PFOS(OR=1.0,95%CI:1.0-1.0,P=0.051)。(2)The subgroup analysis by race showed that the influence of PFDe A on hypertension was statistically different among different races.Compared with the result of Hispanic(OR=0.8,95% CI:0.4-1.4,P=0.394),the result of non-Hispanic was more significant(OR=1.4,95% CI:1.2-1.7,P<0.001),the P value of interactive test analysis was 0.0103.Moreover,whether PFDe A was expressed in the form of continuous variables or quartiles,after fully adjusting confounders,it had similar results.(3)Multiple sensitivity analysis showed similar results.For non-Hispanic,PFDe A had a significant correlation with hypertension in all cases:including taking intp underage participants(OR=1.4,95% CI:1.2-1.8,P< 0.001),restricted to adult participants who did not take antihypertensive drugs(OR=1.6,95%CI:1.2-2.0,P<0.001),and using 130/80 mm Hg to define hypertension(OR=1.4,95%CI:1.1-1.7,P=0.001).For Hispanics,there was no statistically significant relationship in all cases,and the results in different races were statistically significant.When PFDe A was expressed in quartile form,it also had similar results.(4)Through smooth curve fitting,it was found that there was a positive linear relationship between serum concentration of PFDe A and blood pressure level for non-Hispanic adults who did not take antihypertensive drugs,and the results of linear regression suggested that this positive linear relationship had statistically significance,whether systolic blood pressure(β=0.7,95% CI:0.2–1.1,P=0.006)or diastolic blood pressure(β=0.8,95% CI:0.4–1.2,P<0.001).Conclusion:This study showed that PFDe A exposure was associated with hypertension in non-Hispanics adults.Moreover,there was a positive association between PFDe A and blood pressure in non-Hispanics who did not take antihypertensive drugs.