Perfluoroalkyl substances and blood pressure in exposed young population in the Veneto Region, Italy

Abstract Background Residents in a large area of the Veneto Region (North-Eastern Italy) were exposed to perfluoroalkyl substances (PFASs) via drinking water. Studies on the association between PFASs and blood pressure (BP) levels are limited and results are inconsistent. Using cross-sectional data from the Regional health surveillance program, we aimed to quantify the associations between PFAS serum concentrations and blood pressure and hypertension prevalence. Methods The study included 16,224 individuals aged 20-39 years. Pregnant women (n = 327), participants with self-reported diagnosis or under treatment (n = 296) or with missing information on the selected covariates (n = 114) were excluded, leaving 15,487 subjects. Hypertension (HYP) was defined as any self-reported diagnosis, use of antihypertensive drugs, or raised systolic/diastolic blood pressure (SBP)≥140, DBP ≥90 mmHg). Serum PFASs were measured by HPLC-MS. Generalized additive models were used to investigate the relation between each PFAS (perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), perfluorohexane sulfonic acid (PFHxS), and perfluorononanoic acid (PFNA)) ln transformed and by decile, and SBP, DBP, HYP, adjusted for potential confounders. Results Both SBP and DBP increased significantly with an increase in the ln-transformed serum PFASs concentration in a monotonic way. The predicted increase in SBP and DBP were 1.62 (95% CI = 0.69, 2.55), 1.64 mmHg (95% CI = 0.96, 2.31) from lowest to highest decile of PFOA. The associations were stronger for SBP in men and DBP in women. One unit increase in each ln-PFAS was positively associated with an increased odds of HYP in men: PFOA OR = 1.07 (1.01-1.14), PFOS OR = 1.18 (1.05-1.32), PFHxS OR = 1.11 (1.03-1.19), PFNA OR = 1.19 (1.01-1.41). Conclusions Our findings suggest that exposure to PFAS is associated with increased blood pressure and thus may contribute as a risk factor for the development of cardiovascular diseases. Key messages Serum PFASs were associated with raised systolic blood pressure in men and diastolic blood pressure in women in a large highly exposed young adult population. Serum PFASs were associated with raised prevalence of hypertension in men.

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Perfluoroalkyl Substances Are Associated With Elevated Blood Pressure and Hypertension in Highly Exposed Young Adults

10.21203/rs.3.rs-50686/v1 ◽

2020 ◽

Author(s):

Gisella Pitter ◽

Maryam Zare Jeddi ◽

Giulia Barbieri ◽

Massimo Gion ◽

Aline S.C. Fabricio ◽

...

Keyword(s):

Blood Pressure ◽

Diastolic Blood Pressure ◽

Sulfonic Acid ◽

Antihypertensive Drugs ◽

Target Organ Damage ◽

Adverse Outcomes ◽

Additive Models ◽

Perfluoroalkyl Substances ◽

Surveillance Program ◽

Elevated Systolic Blood Pressure

Abstract Background Residents in a large area of North-Eastern Italy were exposed to perfluoroalkyl substances (PFAS) via drinking water. Studies on the association between PFAS and blood pressure levels are limited and results inconsistent. Using cross-sectional data from the Regional health surveillance program, we aimed to quantify the associations between PFAS serum concentrations and blood pressure and hypertension prevalence. Methods The study included 16,224 individuals aged 20-39 years. Pregnant women (n=327), or individuals with missing information on the selected covariates (n=111) were excluded, leaving 15,786 subjects. Hypertension was defined as any self-reported diagnosis, use of antihypertensive drugs, or elevated systolic blood pressure (SBP)/diastolic blood pressure (DBP). Generalized additive models were used to investigate the relation between each PFAS (perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), perfluorohexane sulfonic acid (PFHxS), and perfluorononanoic acid (PFNA)) ln transformed and by decile, and SBP, DBP, hypertension, adjusted for potential confounders. Results Both SBP and DBP increased significantly with an increase in the ln-transformed serum PFAS concentrations in a monotonic way. The predicted increase in SBP and DBP were 1.54 mmHg (95%CI 0.61-2.47), 1.60 mmHg (95%CI 0.92-2.27) from lowest to highest decile of PFOA. The associations were stronger for SBP in men and DBP in women. One unit increase in each natural log transformed PFAS was positively associated with an increased odd of hypertension in men: PFOA OR=1.06 (1.01-1.11), PFOS OR=1.13 (1.03-1.23), PFHxS OR=1.08 (1.02-1.15), PFNA OR=1.20 (1.02-1.40). Conclusions Our findings suggest that serum PFAS concentrations were associated with moderately increased systolic and diastolic blood pressure in a large highly exposed young adult population. Although the magnitude of the observed effect was relatively small, if confirmed it would be of clinical significance since even small increases in blood pressure levels at population level may be associated to a raised risk of adverse outcomes such as cardiovascular disease and target organ damage.

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Perfluoroalkyl substances are associated with elevated blood pressure and hypertension in highly exposed young adults

10.21203/rs.3.rs-50686/v2 ◽

2020 ◽

Author(s):

Gisella Pitter ◽

Maryam Zare Jeddi ◽

Giulia Barbieri ◽

Massimo Gion ◽

Aline S.C. Fabricio ◽

...

Keyword(s):

Blood Pressure ◽

Diastolic Blood Pressure ◽

Sulfonic Acid ◽

Antihypertensive Drugs ◽

Target Organ Damage ◽

Adverse Outcomes ◽

Additive Models ◽

Perfluoroalkyl Substances ◽

Surveillance Program ◽

Elevated Systolic Blood Pressure

Abstract BackgroundResidents in a large area of North-Eastern Italy were exposed to perfluoroalkyl substances (PFAS) via drinking water. Studies on the association between PFAS and blood pressure levels are limited, and results are inconsistent. Using cross-sectional data from the Regional health surveillance program, we aimed to quantify the associations between PFAS serum concentrations and blood pressure and hypertension prevalence.MethodsThe study comprised 16,224 individuals aged 20-39 years. Pregnant women (n=327), or individuals with missing information on the selected covariates (n=111) were excluded, leaving 15,786 subjects for the analyses. Hypertension was defined as any self-reported diagnosis, use of antihypertensive drugs, or elevated systolic blood pressure (SBP≥140 mmHg)/diastolic blood pressure (DBP≥90 mmHg). Generalized additive models were used to investigate the relation between perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), perfluorohexane sulfonic acid (PFHxS), and perfluorononanoic acid (PFNA)) natural log (ln) transformed and by decile, and SBP, DBP, hypertension, adjusted for potential confounders.ResultsBoth SBP and DBP increased significantly with an increase in the ln-transformed serum PFAS concentrations in a monotonic way. The predicted increase in SBP and DBP were 1.54 mmHg (95%CI 0.61-2.47), 1.60 mmHg (95%CI 0.92-2.27) from lowest to highest decile of PFOA. The associations were stronger for SBP in men and for DBP in women. One unit increase in each In-transformed PFAS was positively associated with an increased odd of hypertension in men: PFOA OR=1.06 (1.01-1.11), PFOS OR=1.13 (1.03-1.23), PFHxS OR=1.08 (1.02-1.15), PFNA OR=1.20 (1.02-1.40).ConclusionsOur findings suggest that serum PFAS concentrations were associated with increased systolic and diastolic blood pressure in a large highly exposed young adult population. Although the magnitude of the observed effect was relatively small, if confirmed it would be of public health relevance since even small increases in blood pressure levels at the population level may be associated to a raised risk of adverse outcomes such as cardiovascular disease and target organ damage.

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Perfluoroalkyl substances are associated with elevated blood pressure and hypertension in highly exposed young adults

Environmental Health ◽

10.1186/s12940-020-00656-0 ◽

2020 ◽

Vol 19 (1) ◽

Author(s):

Gisella Pitter ◽

Maryam Zare Jeddi ◽

Giulia Barbieri ◽

Massimo Gion ◽

Aline S. C. Fabricio ◽

...

Keyword(s):

Blood Pressure ◽

Diastolic Blood Pressure ◽

Sulfonic Acid ◽

Antihypertensive Drugs ◽

Target Organ Damage ◽

Adverse Outcomes ◽

Additive Models ◽

Perfluoroalkyl Substances ◽

Surveillance Program ◽

Elevated Systolic Blood Pressure

Abstract Background Residents in a large area of North-Eastern Italy were exposed to perfluoroalkyl substances (PFAS) via drinking water. Studies on the association between PFAS and blood pressure levels are limited, and results are inconsistent. Using cross-sectional data from the Regional health surveillance program, we aimed to quantify the associations between PFAS serum concentrations and blood pressure and hypertension prevalence. Methods The study comprised 16,224 individuals aged 20–39 years. Pregnant women (n = 327), or individuals with missing information on the selected covariates (n = 111) were excluded, leaving 15,786 subjects for the analyses. Hypertension was defined as any self-reported diagnosis, use of antihypertensive drugs, or elevated systolic blood pressure (SBP ≥ 140 mmHg)/diastolic blood pressure (DBP ≥ 90 mmHg). Generalized additive models were used to investigate the relation between perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), perfluorohexane sulfonic acid (PFHxS), and perfluorononanoic acid (PFNA)) natural log (ln) transformed and by decile, and SBP, DBP, hypertension, adjusted for potential confounders. Results Both SBP and DBP increased significantly with an increase in the ln-transformed serum PFAS concentrations in a monotonic way. The predicted increase in SBP and DBP were 1.54 mmHg (95%CI 0.61–2.47), 1.60 mmHg (95%CI 0.92–2.27) from lowest to highest decile of PFOA. The associations were stronger for SBP in men and for DBP in women. One unit increase in each In-transformed PFAS was positively associated with an increased odd of hypertension in men: PFOA OR = 1.06 (1.01–1.11), PFOS OR = 1.13 (1.03–1.23), PFHxS OR = 1.08 (1.02–1.15), PFNA OR = 1.20 (1.02–1.40). Conclusions Our findings suggest that serum PFAS concentrations were associated with increased systolic and diastolic blood pressure in a large highly exposed young adult population. Although the magnitude of the observed effect was relatively small, if confirmed it would be of public health relevance since even small increases in blood pressure levels at the population level may be associated to a raised risk of adverse outcomes such as cardiovascular disease and target organ damage.

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Associations of Perfluoroalkyl Substances with Prevalence of Metabolic Syndrome in Highly Exposed Young Adult Community Residents—A Cross-Sectional Study in Veneto Region, Italy

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18031194 ◽

2021 ◽

Vol 18 (3) ◽

pp. 1194

Author(s):

Maryam Zare Jeddi ◽

Teresa Dalla Zuanna ◽

Giulia Barbieri ◽

Aline S. C. Fabricio ◽

Francesca Daprà ◽

...

Keyword(s):

Blood Pressure ◽

Metabolic Syndrome ◽

Young Adult ◽

Sulfonic Acid ◽

Serum Levels ◽

Additive Models ◽

Elevated Blood Pressure ◽

Perfluoroalkyl Substances ◽

Veneto Region ◽

Elevated Blood

Background: Studies on the association between perfluoroalkyl substances (PFAS) and metabolic syndrome (MetS) are limited, and results are inconsistent. We aimed to examine the associations between PFAS serum levels and the prevalence of MetS among highly exposed young adults (ages 20–39) residents of a large area of the Veneto Region (North-Eastern Italy) primarily stemming from PFAS water contamination before September 2013. A total of 15,876 eligible young adult residents living in the investigated municipalities were enrolled in the study from January 2017 to July 2019. Methods: MetS was defined by using a modified harmonized definition requiring the presence of 3 of the following: obesity (body mass index ≥30), elevated triglyceride (TG), reduced high-density lipoprotein cholesterol, elevated blood pressure, and hemoglobin A1c ≥ 6.1% or self-reported diabetes mellitus or drug treatment for hyperglycemia. Multivariable generalized additive models were performed to identify the associations between four serum PFAS, including perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid (PFOA), perfluorohexane sulfonic acid (PFHxS), and perfluorononanoic acid (PFNA), and risk of MetS controlling for potential confounders. Results: A total of 1282 participants (8.1%) met the criteria of MetS with a higher prevalence among men. PFOA, PFHxS, and PFNA were not associated with the risk of MetS, whereas PFOS showed a consistent protective effect against the risk of MetS (OR 0.76, (95% CI: 0.69, 0.85) per ln-PFOS). However, we found statistically significant positive associations between PFAS serum levels and individual components of MetS, mainly elevated blood pressure and elevated TG. Conclusion: Our results did not support a consistent association between PFAS and MetS and conflicting findings were observed for individual components of MetS.

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Perfluoroalkyl substances and lipid profile in exposed pregnant women in the Veneto Region, Italy

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.109 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

T Dalla Zuanna ◽

G Barbieri ◽

G Pitter ◽

M Zare Jeddi ◽

F Daprà ◽

...

Keyword(s):

Pregnant Women ◽

Lipid Profile ◽

Plasma Concentrations ◽

Density Lipoprotein ◽

Additive Models ◽

Lipoprotein Cholesterol ◽

Perfluoroalkyl Substances ◽

Surveillance Program ◽

Veneto Region ◽

Exposed Population

Abstract Background Perfluoroalkyl substances (PFASs) are persistent and widespread environmental pollutants. Residents of a large area of the Veneto Region (North-Eastern Italy) were exposed to high concentrations of PFASs through drinking water from the late-1970s to 2013. PFASs have been consistently associated with raised serum lipids, but only few studies have been conducted among pregnant women, and none has stratified analyses by trimesters of gestation. Our main objective was to evaluate the association between perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA) levels and lipid profiles in high-exposed pregnant women. Methods A cross-sectional analysis was conducted in 319 pregnant women (age 14-48 years) recruited in the Regional health surveillance program. Serum PFASs were measured by HPLC-MS/MS. Non-fasting serum total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C) were measured by enzymatic assays in automated analysers, and low-density lipoprotein cholesterol (LDL-C) was calculated. The associations between ln-transformed PFASs (and categorized into quartiles) and lipids were assessed using generalized additive models. Analyses were adjusted for potential confounders and stratified according to pregnancy trimester. Results In the first trimester, plasma concentrations of both PFOA and PFOS were positively associated with TC. However in the third trimester PFOA levels were instead inversely significantly associated with TC and LDL-C levels. Overall, both PFOA and PFOS were positively associated with HDL-C, and PFOA negatively with LDL-C. Conclusions In a small highly exposed population of pregnant women, the associations between PFASs concentrations and lipid profile were modified by trimester of gestation. Patterns late in pregnancy were different to the positive associations with LDL-C generally found. Differential transfer and bioaccumulation of lipids and PFAS in the placenta across gestation might explain our findings. Key messages This study provides evidence of different patterns of PFAS associations with lipids in pregnant women across the trimesters of gestation. The different patterns of association from general population studies sheds light on the role of fetal nutrition during pregnancy affecting both lipids and PFAS in serum.

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PFAS Concentrations and Cardiometabolic Traits in Highly Exposed Children and Adolescents

10.20944/preprints202110.0329.v1 ◽

2021 ◽

Author(s):

Cristina Canova ◽

Andrea Di Nisio ◽

Giulia Barbieri ◽

Francesca Russo ◽

Tony Fletcher ◽

...

Keyword(s):

Blood Pressure ◽

Children And Adolescents ◽

Density Lipoprotein ◽

Positive Association ◽

Additive Models ◽

Lipoprotein Cholesterol ◽

Surveillance Program ◽

Z Score ◽

Large Area ◽

Cross Sectional

Background: Residents of a large area of North-Eastern Italy were exposed for decades to high concentrations of perfluoroalkyl and polyfluoroalkyl substances (PFAS) via drinking water. Despite the large amount of evidence in adults of a positive association between serum PFAS and metabolic outcomes, studies focusing on children and adolescents are limited. We evaluated the associations between serum PFAS concentrations and lipid profile, blood pressure and body mass index (BMI) in highly exposed adolescents and children. Methods: A cross-sectional analysis was conducted in 6669 adolescents (14-19 years) and 2693 children (8-11 years) enrolled in the health surveillance program of the Veneto Region. Non-fasting blood samples were obtained and analyzed for perfluorooctanoic acid (PFOA) perfluorooctane sulfonate (PFOS), perfluorohexanesulfonic acid (PFHxS), perfluorononanoic acid (PFNA), total cholesterol (TC) high-density lipoprotein cholesterol (HDL-C) and triglycerides. Low-density lipoprotein cholesterol (LDL-C) was calculated. Systolic and diastolic blood pressure (BP) were measured and BMI z-score accounting for age and sex was estimated. The associations between ln-transformed PFAS (and categorized into quartiles) and continuous outcomes were assessed using generalized additive models. Analyses were stratified by gender and adjusted for potential confounders. Results: Among adolescents, significant associations were detected between all investigated PFAS and TC, LDL-C, and to a fewer extent HDL-C. Among children, PFOS and PFNA had significant associations with TC, LDL-C and HDL-C, while PFOA and PFHxS had significant associations with HDL-C only. Increased serum concentrations of PFAS, particularly PFOS, were associated with decreased BMI z-score. No statistically significant associations were observed between PFAS concentrations and BP. Conclusions: Our study supports a consistent association between PFAS concentration and serum lipids, stronger for PFOS and PFNA and with a greater magnitude among children compared to adolescents, and a negative association of PFAS with BMI.

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An observational study on patient compliance and adverse drug reactions of antihypertensives drugs in a tertiary care center of Bihar

IP International Journal of Comprehensive and Advanced Pharmacology ◽

10.18231/j.ijcaap.2021.033 ◽

2021 ◽

Vol 6 (4) ◽

pp. 190-193

Author(s):

Mrityunjay Kumar Pandit ◽

Kumar Gaurav ◽

Jeetendra Kumar

Keyword(s):

Blood Pressure ◽

Combination Therapy ◽

Antihypertensive Drugs ◽

Care Center ◽

Adult Population ◽

Tertiary Care ◽

Cross Sectional Study ◽

High Dose ◽

Cross Sectional ◽

Institutional Ethics

Hypertension is among the most common non-communicable and lifestyle disease in our country that affects adult population of both the genders from all socio-economic backgrounds and urban and rural population. In-spite of this, early diagnosis and appropriate treatment are suboptimal. Adherence of prescribed treatment has been studied in patients of hypertension in this study. : An observational and cross-sectional study was conducted in the Department of Pharmacology, Jawahar Lal Nehru Medical College and Hospital, Bhagalpur, Bihar. Prior to the initiation of the study, clearance was obtained from the Institutional Ethics Committee. Study period was between January 2021 and June 2021.A predesigned pretested interview schedule was used to collect the data from the 247 study participants. This schedule contained information related to socio-demographic variables, comorbidity, a format to assess the compliance to antihypertensive drugs prescribed and any adverse event. : A significant improvement in maintain optimal in blood pressure was observed in patients treated with one pill per day as compared to patients prescribed with two and three pills per day. Compliance was significantly better in patients in combination therapy as compared to monotherapy. : Low dose combination therapy has been stated to be more effective than high dose monotherapy in controlling blood pressure. It shows better compliance and lesser incidence of side-effects.

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Trends in blood pressure, lipids, lipoproteins and glucose metabolism in the Northern Sweden MONICA project 1986 - 99

Scandinavian Journal of Public Health ◽

10.1080/14034950310001397 ◽

2003 ◽

Vol 31 (61_suppl) ◽

pp. 43-50 ◽

Cited By ~ 12

Author(s):

Jan-HÅkan Jansson ◽

Kurt Boman ◽

Torbjörn Messner

Keyword(s):

Blood Pressure ◽

Antihypertensive Drugs ◽

Adult Population ◽

Hdl Cholesterol ◽

Total Serum ◽

Total Serum Cholesterol ◽

Northern Sweden ◽

Population Total ◽

The Past ◽

Monica Project

Aim: The authors present an analysis of time trends in blood pressure, hypertension, and lipids in the adult population of Northern Sweden over the period 1986 - 99. Method: Four population surveys were undertaken with new and independent cohorts, 25 - 64 years old. Results: Small changes in blood pressure were observed during the study period with increased systolic blood pressure in men and decreased diastolic blood pressure in women. The proportion with high blood pressure was found to be constant over time and only 50% were prescribed antihypertensive drugs and of these only a minority were normotensive. Total serum cholesterol decreased from 6.4 to 5.7 mmol/l in men and from 6.3 to 5.7 mmol/l in women over the study period, and this was accompanied by an increase in HDL cholesterol by about 10% in both sexes. The proportion with high cholesterol decreased from 41% to 26%. Triglycerides increased between 1986 and 1990 and no further changes were found in the following surveys. Conclusion: In the Northern Sweden MONICA population total cholesterol has declined and HDL cholesterol has increased during the past 13 years and small changes in blood pressure have been observed for both men and women.

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Non-pharmacological methods in the treatment of resistant hypertension

Folia Medica ◽

10.2478/v10153-011-0081-y ◽

2012 ◽

Vol 54 (2) ◽

pp. 5-12 ◽

Cited By ~ 2

Author(s):

Kostadin N. Kichukov ◽

Hristo V. Dimitrov ◽

Lora K. Nikolova ◽

Ivo S. Petrov ◽

Maria P. Tokmakova

Keyword(s):

Blood Pressure ◽

Resistant Hypertension ◽

Renal Denervation ◽

Antihypertensive Drugs ◽

Adult Population ◽

Clinical Problem ◽

Renal Sympathetic Denervation ◽

Great Promise ◽

Long Term Effects ◽

Blood Pressure Targets

ABSTRACT INTRODUCTION: Arterial hypertension is the most common chronic cardiovascular disease affecting about 25% of the adult population. Meta-analyses have demonstrated a linear relationship between blood pressure and the risk of cardiovascular events. Resistant hypertension defined as failure to reach blood pressure targets despite treatment with three antihypertensive drugs including a diuretic represents a serious clinical problem. It has been estimated that it affects between 8.9% and 12.8% of all treated hypertensive subjects. In resistant hypertension the optimal blood pressure is illusive despite very well tailored therapy. OBJECTIVE: Management of resistant hypertension is exactly the fi eld where blood pressurecontrolling non-pharmacological methods fi t best. The present article aims at throwing light on these methods’ principles of action, on who the target patient groups are and the respective results. Two methods are especially reviewed here: the carotid barorefl ex stimulation and the transcatheter renal sympathetic denervation. Current results from the use of renal denervation suggest stable effi ciency of the method, the results becoming signifi cant 6 months after the procedure is applied and sustained for two years in the follow-up. As much as 90% of the treated patients respond to the procedure. The transcatheter renal denervation is associated with only 2.61% of procedural complications. The barorefl ex carotid stimulation, too, is known to produce a stable effect on blood pressure: the effect become obvious at 12 months in 88% of the treated subjects. The neurologic complications associated with the procedure are reported to occur in 4.4% of cases. CONCLUSION: The present review article clearly demonstrates that non-pharmacological methods for treatment of resistant hypertension show great promise despite some open questions concerning their long term effects and procedural safety.

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Results of a National Therapeutic Trial Conducted in 10 000 Hypertensive Patients by 2000 General Practitioners

Clinical Science ◽

10.1042/cs055353s ◽

1978 ◽

Vol 55 (s4) ◽

pp. 353s-354s

Author(s):

A. Jouve ◽

L. Goldet ◽

M. Mathieu

Keyword(s):

Blood Pressure ◽

Side Effects ◽

Diastolic Blood Pressure ◽

General Practitioners ◽

Antihypertensive Drugs ◽

Drop Out ◽

Therapeutic Trial ◽

Hypertensive Patients ◽

Supine Diastolic Blood Pressure ◽

Treatment Groups

1. 10 294 hypertensive patients were treated and followed by 2200 general practitioners under the supervision of 130 cardiologists and nephrologists. 2. The treatment groups, randomly allocated, were designated to use three distinct antihypertensive drugs, administered alone, and combined two-by-two. 3. Some 75% of patients had a supine diastolic blood pressure of less than 95 mmHg after 4 months treatment. 4. A total of 12% of patients had dropped out by 4 months from entry; no clear relationship was established between side effects and drop out.

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