Association between per- and polyfluoroalkyl substances and risk of hypertension: a systematic review and meta-analysis

Fang Xiao; Ziwen An; Junli Lv; Xiaoyi Sun; Heming Sun; Yi Liu; Xuehui Liu; Huicai Guo

doi:10.3389/fpubh.2023.1173101

Association between per- and polyfluoroalkyl substances and risk of hypertension: a systematic review and meta-analysis

Front Public Health. 2023 Aug 2:11:1173101. doi: 10.3389/fpubh.2023.1173101. eCollection 2023.

Authors

Fang Xiao¹, Ziwen An¹, Junli Lv¹, Xiaoyi Sun², Heming Sun¹, Yi Liu¹, Xuehui Liu^{2

3}, Huicai Guo^{1

3}

Affiliations

¹ Department of Toxicology, School of Public Health, Hebei Medical University, Shijiazhuang, China.
² Department of Occupational and Environmental Health, School of Public Health, Hebei Medical University, Shijiazhuang, China.
³ Hebei Key Laboratory of Environment and Human Health, Shijiazhuang, China.

Abstract

Background: Existing evidence indicates that exposure to per- and polyfluoroalkyl substances (PFASs) may increase the risk of hypertension, but the findings are inconsistent. Therefore, we aimed to explore the relationship between PFASs and hypertension through this systematic review and meta-analysis.

Methods: We searched PubMed, Embase, and the Web of Science databases for articles published in English that examined the relationship between PFASs and hypertension before 13 August 2022. The random effects model was used to aggregate the evaluation using Stata 15.0 for Windows. We also conducted subgroup analyses by region and hypertension definition. In addition, a sensitivity analysis was carried out to determine the robustness of the findings.

Results: The meta-analysis comprised 15 studies in total with 69,949 individuals. The risk of hypertension was substantially and positively correlated with exposure to perfluorooctane sulfonate (PFOS) (OR = 1.31, 95% CI: 1.14, 1.51), perfluorooctanoic acid (PFOA) (OR = 1.16, 95% CI: 1.07, 1.26), and perfluorohexane sulfonate (PFHxS) (OR = 1.04, 95% CI: 1.00, 1.09). However, perfluorononanoic acid (PFNA) exposure and hypertension were not significantly associated (OR = 1.08, 95% CI: 0.99, 1.17).

Conclusion: We evaluated the link between PFASs exposure and hypertension and discovered that higher levels of PFOS, PFOA, and PFHxS were correlated with an increased risk of hypertension. However, further high-quality population-based and pathophysiological investigations are required to shed light on the possible mechanism and demonstrate causation because of the considerable variability.

Systematic review registration: https://www.crd.york.ac.uk/prospero/ PROSPERO, registration number: CRD 42022358142.

Keywords: environmental pollutants; high blood pressure; hypertension; meta-analysis; per-and polyfluoroalkyl substances.

Publication types

Meta-Analysis
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Alkanesulfonates
Fluorocarbons* / adverse effects
Humans
Hypertension* / epidemiology

Substances

perflexane
perfluorooctane sulfonic acid
perfluorooctanoic acid
Alkanesulfonates
Fluorocarbons

Grants and funding

This study was supported by grants from the National Natural Science Fund of China (21976050) and the Science and Technology Program of Hebei Province (21377779D).