{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:53:58Z","timestamp":1792788838678,"version":"4.5.0"},"reference-count":76,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T00:00:00Z","timestamp":1765324800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Fundamental Research Program of Shanxi Province","award":["202403021222432"],"award-info":[{"award-number":["202403021222432"]}]},{"name":"Shanxi Health Committee Foundation Project","award":["2024057"],"award-info":[{"award-number":["2024057"]}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>This systematic review and meta-analysis aimed to quantify the association between environmental and occupational lead exposure and the risk of various hypertension subtypes. We further evaluated this relationship through a dose\u2013response analysis to provide a scientific basis for targeted public health interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Observational studies on lead exposure and hypertension were searched from Chinese\/English databases (inception to June 9, 2025). Two researchers independently screened studies, extracted data, and assessed bias risk. Random-effects meta-analysis calculated pooled ORs (95% CIs); meta-regression\/subgroup analyses explored heterogeneity. Egger\u2019s test evaluated publication bias, sensitivity analyses verified result robustness, and dose\u2013response analysis was applied to multi-level exposure data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Result<\/jats:title>\n                    <jats:p>\n                      24 studies (181,500 participants) were included. Lead exposure correlated significantly with hypertension (pooled OR\u202f=\u202f1.27, 95% CI: 1.20\u20131.34) with high heterogeneity (I\n                      <jats:sup>2<\/jats:sup>\n                      =\u202f91.4%,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). Stronger associations were found for blood lead (OR\u202f=\u202f1.32), essential hypertension (OR\u202f=\u202f1.31), and resistant hypertension (OR\u202f=\u202f1.36); no significant associations for bone lead or gestational hypertension. Hypertension risk rose sharply at blood lead \u2265 0.107\u202f\u03bcg\/dl, reaching OR\u202f=\u202f4.85 at 8.435 \u03bcg\/dl. Potential publication bias existed, but sensitivity analyses confirmed robustness.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Lead exposure is a hypertension risk factor with a clear dose\u2013response relationship. It is recommended to include blood lead in hypertension risk assessment and set a blood lead action level of &amp;lt; 0.107\u202f\u03bcg\/dl for high-risk groups to reduce hypertension burden from lead pollution.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/inplasy.com\/inplasy-2025-9-0008\/<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2025.1706805","type":"journal-article","created":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T06:39:11Z","timestamp":1765348751000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Relationship between lead exposure and different types of hypertension: systematic review and dose\u2013response meta-analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Peilin","family":"Yang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tianyi","family":"Ji","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhendong","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiayuan","family":"Song","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongwei","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haixia","family":"Fan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,12,10]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"825","DOI":"10.1016\/S0140-6736(14)62256-X","article-title":"A 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Pharmacol"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"590308","DOI":"10.3389\/fphys.2020.590308","article-title":"Chronic low-level lead exposure increases mesenteric vascular reactivity: role of cyclooxygenase-2-derived prostanoids","volume":"11","author":"Sim\u00f5es","year":"2020","journal-title":"Front Physiol"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"17012","DOI":"10.1289\/EHP5925","article-title":"Blood lead levels in U.S. women of childbearing age, 1976-2016","volume":"128","author":"Ettinger","year":"2020","journal-title":"Environ Health Perspect"},{"key":"ref53","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1002\/ajim.4700110204","article-title":"Occupational exposure to lead and blood pressure: a study in 105 workers","volume":"11","author":"de Kort","year":"1987","journal-title":"Am J Ind Med."},{"key":"ref54","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1161\/01.HYP.10.4.447","article-title":"Pregnancy hypertension, blood pressure during labor, and blood lead levels","volume":"10","author":"Rabinowitz","year":"1987","journal-title":"Hypertension."},{"key":"ref55","first-page":"1171","article-title":"The relationship of bone and blood lead to hypertension","volume":"275","author":"Hu","year":"1996","journal-title":"The Normative Aging Study. Jama."},{"key":"ref56","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.1093\/aje\/kwf163","article-title":"Increases in hypertension and blood pressure during pregnancy with increased bone lead levels","volume":"156","author":"Rothenberg","year":"2002","journal-title":"Am J Epidemiol."},{"key":"ref57","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1093\/aje\/kwj060","article-title":"Association of blood lead and tibia lead with blood pressure and hypertension in a community sample of older adults","volume":"163","author":"Martin","year":"2006","journal-title":"Am J Epidemiol."},{"key":"ref58","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1016\/j.ijheh.2005.04.004","article-title":"Is lead considered as a risk factor for high blood pressure during menopause period among Saudi women?","volume":"208","author":"Al-Saleh","year":"2005","journal-title":"Int J Hyg Environ Health."},{"key":"ref59","doi-asserted-by":"crossref","first-page":"1526","DOI":"10.1289\/ehp.0800488","article-title":"Maternal blood lead levels and the risk of pregnancy-induced hypertension: the EDEN cohort study","volume":"117","author":"Yazbeck","year":"2009","journal-title":"Environ Health Perspect."},{"key":"ref60","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1007\/s12011-016-0699-y","article-title":"Association of Blood Pressure with Exposure to Lead and Cadmium: Analysis of Data from the 2008-2013 Korean National Health and Nutrition Examination Survey","volume":"174","author":"Lee","year":"2016","journal-title":"Biol Trace Elem Res."},{"key":"ref61","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/j.envres.2016.05.015","article-title":"Low-level exposure to lead, blood pressure, and hypertension in a population-based cohort","volume":"149","author":"Gambelunghe","year":"2016","journal-title":"Environ 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Assoc."},{"key":"ref65","doi-asserted-by":"crossref","first-page":"e12107","DOI":"10.1002\/1348-9585.12107","article-title":"Does low lead exposure affect blood pressure and hypertension?","volume":"62","author":"Kim","year":"2020","journal-title":"J Occup Health."},{"key":"ref66","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.preghy.2020.07.014","article-title":"Lead exposure and association with angiogenic factors and hypertensive disorders of pregnancy","volume":"22","author":"Johnson","year":"2020","journal-title":"Pregnancy Hypertens."},{"key":"ref67","doi-asserted-by":"crossref","first-page":"e015533","DOI":"10.1161\/JAHA.119.015533","article-title":"Association Between Blood Lead Level and Uncontrolled Hypertension in the US Population (NHANES 1999-2016)","volume":"9","author":"Miao","year":"2020","journal-title":"J Am Heart 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