In view of the declining environmental lead exposure in the United States, we analyzed the National Health and Nutrition Examination Survey (2003-2010) for association of blood pressure and hypertension with blood lead. The 12 725 participants included 21.1% blacks, 20.5% Hispanics, 58.4% whites, and 48.7% women. Blacks compared with non-Blacks had higher systolic and diastolic pressures (126.5 versus 123.9 and 71.9 versus 69.6 mm Hg) and higher hypertension prevalence (44.7 versus 36.8%). Blood lead was lower in whites than in non-whites (1.46 versus 1.57 μg/dL) and in women than in men (1.25 versus 1.80 μg/dL). In multivariable analyses of all participants, blood lead doubling was associated with higher (P≤0.0007) systolic and diastolic pressure (+0.76 mm Hg; 95% confidence interval, 0.38-1.13 and +0.43 mm Hg; 0.18-0.68), but not with the odds of hypertension (0.95; 0.90-1.01; P=0.11). Associations with blood lead were nonsignificant (P≥0.09) for systolic pressure in women and for diastolic pressure in non-whites. Among men, systolic pressure increased with blood lead (P≤0.060) with effect sizes associated with blood lead doubling ranging from +0.65 mm Hg in whites to +1.61 mm Hg in blacks. For systolic pressure, interactions of ethnicity and sex with blood lead were all significant (P≤0.019). In conclusion, small and inconsistent effect sizes in the associations of blood pressure with blood lead likely exclude current environmental lead exposure as a major hypertension cause in the United States.
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