{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:54:57Z","timestamp":1787018097031,"version":"build-2736575974"},"reference-count":39,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"21","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2018,11,6]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Bone lead offers a better method over blood lead measurement to discern long\u2010term lead exposure and accumulation. We examined the risk of resistant hypertension based on bone lead levels in a prospective cohort study of NAS (Normative Aging Study).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Participants had clinic data on hypertension (systolic blood pressure, diastolic blood pressure, and antihypertension medication), lead (blood, bone\u2010patella, bone\u2010tibia), and demographic and confounding variables. Cases of resistant hypertension were identified by meeting criteria for: (1) inadequate systolic blood pressure (&gt;140\u00a0mm\u00a0Hg) or diastolic blood pressure (&gt;90\u00a0mm\u00a0Hg) while taking 3 medications or (2) requiring &gt;4 medications for blood pressure control. A modified Poisson regression was used for model analysis. Of the 475 participants, 97 cases of resistant hypertension (20.4%) were identified. Among the cases of resistant hypertension, the median tibia and patella lead levels were 20\u00a0\u03bcg\/g and 25\u00a0\u03bcg\/g, respectively, while median tibia and patella lead levels were 20\u00a0\u03bcg\/g and 27.5\u00a0\u03bcg\/g, respectively, in participants without resistant hypertension. Tibia lead demonstrated a significant association with resistant hypertension (relative risk, 1.19; 95% confidence interval, 1.01\u20131.41 [\n                      <jats:italic>P<\/jats:italic>\n                      =0.04]) per interquartile range increase in tibia lead (13\u201328.5\u00a0\u03bcg\/g). Patella lead was not associated with resistant hypertension (relative risk, 1.10; 95% confidence interval, 0.92\u20131.31 [\n                      <jats:italic>P<\/jats:italic>\n                      =0.31]) per interquartile range increase in patella lead (18\u201340\u00a0\u03bcg\/g). Blood lead levels were not significantly associated with resistant hypertension (relative risk, 1.11; 95% confidence interval, 0.88\u20131.40 [\n                      <jats:italic>P<\/jats:italic>\n                      =0.38]).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Tibia lead represents a novel risk factor for resistant hypertension. Our study demonstrates an increased association between tibia lead and resistant hypertension status, with an increased risk of 19% per 1 interquartile range increase in tibia lead.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.118.010014","type":"journal-article","created":{"date-parts":[[2018,10,24]],"date-time":"2018-10-24T05:04:24Z","timestamp":1540357464000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":30,"title":["Low\u2010Level Cumulative Lead and Resistant Hypertension: A Prospective Study of Men Participating in the Veterans Affairs Normative Aging Study"],"prefix":"10.1161","volume":"7","author":[{"given":"Alexander R.","family":"Zheutlin","sequence":"first","affiliation":[{"name":"Department of Epidemiology University of Michigan Ann Arbor MI"},{"name":"University of Michigan Medical School Ann Arbor MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Howard","family":"Hu","sequence":"additional","affiliation":[{"name":"School of Public Health, University of Washington Seattle WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc G.","family":"Weisskopf","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Harvard T.H. Chan School of Public Health Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Sparrow","sequence":"additional","affiliation":[{"name":"VA Normative Aging Study Veterans Affairs Boston Health Care System Boston MA"},{"name":"Department of Medicine Boston University School of Medicine Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pantel S.","family":"Vokonas","sequence":"additional","affiliation":[{"name":"VA Normative Aging Study Veterans Affairs Boston Health Care System Boston MA"},{"name":"Department of Medicine Boston University School of Medicine Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung Kyun","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Epidemiology University of Michigan Ann Arbor MI"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","first-page":"1","article-title":"Hypertension among adults in the United States: National Health and Nutrition Examination Survey, 2011\u20132012","volume":"133","author":"Nwankwo T","year":"2013","unstructured":"Nwankwo T, Yoon SS, Burt V, Gu Q. 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