Cumulative lead exposure, blood pressure, and pulse pressure: a longitudinal case-control study.


  • Ziadi Boukerma Université Farhat Abbas Sétif 1. Algérie
  • Ahmed-Lakhdar Behlouli Université Farhat Abbas Sétif 1.
  • Ammar Terra Université Farhat Abbas Sétif 1.



Blood pressure, pulse pressure, blood lead, cumulative blood lead, lead exposure.


Background: The action of lead on blood pressure is always subject to discussion. To this, is added the possible action of the lead on the pulse pressure. Objective: To evaluate the effect of lead on blood pressure and pulse pressure by a longitudinal case-control study (275 exposed people and 282 controls). Method: The studied parameters of this study came from the medical follow-up records of the workers. Multivariate analyses and the study of survival time are made by SPSS version 20 software. Results: mean systolic and diastolic pressures were significantly higher (p < 0.000) in lead-exposed workers than in controls. Ditto for pulsed pressure (p < 0.000). There are almost two times more systolic and diastolic hypertension in lead-exposed workers. Survival was significantly much lower in the exposed cohort. Conclusion: The average lead as well as the cumulative lead act both on the pressure parameters.

Author Biographies

Ziadi Boukerma, Université Farhat Abbas Sétif 1. Algérie

Université Farhat Abbas Sétif1. Faculté de Médecine, Service de Médecine du Travail.

Université Farhat Abbas Sétif 1. Faculté de Médecine, Laboratoire Santé Environnement des Hauts Plateaux sétifiens.

Ahmed-Lakhdar Behlouli, Université Farhat Abbas Sétif 1.

Université Farhat Abbas Sétif1. Faculté de Médecine, Service de Médecine du Travail

Ammar Terra, Université Farhat Abbas Sétif 1.

Université Farhat Abbas Sétif1. Faculté de Médecine, Service de Médecine du Travail


Alghasham, A. A., Meki, A. R. M. A., & Ismail, H. A. S. (2011). Association of Blood Lead level with elevated Blood Pressure in Hypertensive Patients. Int J Health Sci (Qassim), 5(1), 17-27.

Andersson, O. K., Almgren, T., Persson, B., Samuelsson, O., Hedner, T., & Wilhelmsen, L. (1998). Survival in treated hypertension: follow up study after two decades. BMJ, 317(7152), 167-171.

Apostoli, P., Corulli, A., Carta, P., Soleo, L., DiLorenzo, L., Abritti, G., . . . Mutti, A. ( 2005 ). Lead and blood pressure. G Ital Med Lav Ergon., 27(Suppl 1), 22-32.

Barry, P., & Mossman, D. (1970). Lead concentrations in human tissues. Occup Environ Med, 27(4), 339-351.

Bener, A., Obineche, E., Gillett, M., Pasha, M. A., & Bishawi, B. (2001). Association between blood levels of lead, blood pressure and risk of diabetes and heart disease in workers. Int Arch Occup Environ Health., 74(5), 375-378.

Benetos, A. (1999). Rigidité artérielle, pression pulsée et risque cardiovasculaire. Sang Thrombose Vaisseaux, 11(4), 229-232.

Bénétos, A. (2007). Pression pulsée et risque cardiovasculaire. Un facteur de risque cardiovasculaire indépendant chez l'hypertendu. MÉDECINE, 402-406.

Benetos, A., Rudnichi, A., Safar, M., & Guize, L. (1998). Pulse pressure and cardiovascular mortality in normotensive and hypertensive subjects. Hypertension, 32(3), 560-564.

Benetos, A., Thomas, F., Bean, K. E., Pannier, B., & Guize, L. (2005). Role of modifiable risk factors in life expectancy in the elderly. J Hypertens, 23(10), 1803-1808.

Boutouyrie, P., & Laurent, S. (2004). Remodelage des grosses et petites artères dans l ‘hypertension artérielle. Sang Thrombose Vaisseaux, 16(2), 81-89.

Chalmers, J., MacMahon, S., Mancia, G., Whitworth, J., Beilin, L., Hansson, L., . . . Clark, T. (1999). 1999 World Health Organization-International Society of Hypertension Guidelines for the management of hypertension. Guidelines sub-committee of the World Health Organization. Clinical and experimental hypertension (New York, NY: 1993), 21(5-6), 1009-1060.

Cheng, Y., Schwartz, J., Sparrow, D., Aro, A., Weiss, S. T., & Hu, H. (2001). Bone lead and blood lead levels in relation to baseline blood pressure and the prospective development of hypertension the normative aging study. Am J Epidemiol, 153(2), 164-171.

Chu, N. F., Liou, S. H., Wu, T. N., & Chang, P. Y. (1999). Reappraisal of the relation between blood lead concentration and blood pressure among the general population in Taiwan. Occup Environ Med, 56(1), 30-33.

de Almeida Lopes, A. C. B., Silbergeld, E. K., Navas-Acien, A., Zamoiski, R., da Cunha Martins Jr, A., Camargo, A. E. I., . . . Paoliello, M. M. B. (2017). Association between blood lead and blood pressure: a population-based study in Brazilian adults. Environmental Health, 16(1), 27.

Den Hond, E., Nawrot, T., & Staessen, J. A. (2002). The relationship between blood pressure and blood lead in NHANES III. National Health and Nutritional Examination Survey. J Hum Hypertens, 16(8), 563-568.

Fang, J., Madhavan, S., Cohen, H., & Alderman, M. H. (1995). Measures of blood pressure and myocardial infarction in treated hypertensive patients. J Hypertens, 13(4), 413-420.

Franco, O. H., Peeters, A., Bonneux, L., & De Laet, C. (2005). Blood pressure in adulthood and life expectancy with cardiovascular disease in men and women. Hypertension, 46(2), 280-286.

Glenn, B. S., Bandeen-Roche, K., Lee, B. K., Weaver, V. M., Todd, A. C., & Schwartz, B. S. (2006). Changes in systolic blood pressure associated with lead in blood and bone. Epidemiology., 17(5), 538-544.

Glenn, B. S., Stewart, W. F., Links, J. M., Todd, A. C., & Schwartz, B. S. (2003). The longitudinal association of lead with blood pressure. Epidemiology, 14(1), 30-36.

Harlan, W. R. (1988). The relationship of blood lead levels to blood pressure in the US population. Environ Health Perspect, 78, 9-13.

Hayoz, D. (2005). Athérosclérose: quels sont les marqueurs à disposition du praticien. Rev Med Suisse, 1, 299-305.

Kasperczyk, S., Dziwisz, M., Kasperczyk, A., & Birkner, E. (2002). Influence of lead exposure on arterial hypertension. Wiad Lek., 55(Suppl 1), 230-234.

Kondo, T., Iaria, P., Maufroy, N., Detienne, J.-P., Cuveillier, D., Moreau, I., . . . Safar, M. (2006). Hypertension artérielle et pression pulsée. mt cardio, 2(5), 493-498.

Laurent, S., Katsahian, S., Fassot, C., Tropeano, A.-I., Gautier, I., Laloux, B., & Boutouyrie, P. (2003). Aortic stiffness is an independent predictor of fatal stroke in essential hypertension. Stroke, 34(5), 1203-1206.

Lim, S. S., Vos, T., Flaxman, A. D., Danaei, G., Shibuya, K., Adair-Rohani, H., . . . Andrews, K. G. (2013). A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. The lancet, 380(9859), 2224-2260.

Madhavan, S., Ooi, W. L., Cohen, H., & Alderman, M. H. (1994). Relation of pulse pressure and blood pressure reduction to the incidence of myocardial infarction. Hypertension, 23(3), 395-401.

Møller, L., & Kristensen, T. S. (1992). Blood lead as a cardiovascular risk factor. Am J Epidemiol, 136(9), 1091-1100.

Mourad, J. J. (2000). La pression pulsee: le maillon manquant des facteurs de risque en pathologie vasculaire. Journal des Maladies Vasculaires, 25(2), 89-91.

Nomiyama, K., Nomiyama, H., Liu, S., Tao, Y., Nomiyama, T., & Omae, K. (2002). Lead induced increase of blood pressure in female lead workers. Occup Environ Med, 59(11), 734-738.

Ozturk, M. T., Yavuz, B., Ozkan, S., Ayturk, M., Akkan, T., Ozkan, E., . . . Yılmaz, Ö. H. (2014). Lead Exposure Is Related to Impairment of Aortic Elasticity Parameters. The Journal of Clinical Hypertension, 16(11), 790-793.

Parkinson, D., Hodgson, M., Bromet, E. J., Dew, M. A., & Connell, M. M. (1987). Occupational lead exposure and blood pressure. Occup Environ Med, 44(11), 744-748.

Perlstein, T., Weuve, J., Schwartz, J., Sparrow, D., Wright, R., Litonjua, A., . . . Hu, H. (2007). Cumulative community-level lead exposure and pulse pressure: the normative aging study. Environ Health Perspect, 1696-1700.

Pirkle, J. L., Schwartz, J., Landis, J. R., & Harlan, W. R. (1985). The relationship between blood lead levels and blood pressure and its cardiovascular risk implications. Am J Epidemiol, 121(2), 246-258.

Pocock, S., Shaper, A., Ashby, D., Delves, H., & Clayton, B. (1988). The relationship between blood lead, blood pressure, stroke, and heart attacks in middle-aged British men. Environ Health Perspect, 78, 23.

Poręba, R., Poreba, M., Gać, P., & Andrzejak, R. (2011). Ambulatory blood pressure monitoring and structural changes in carotid arteries in normotensive workers occupationally exposed to lead. Hum Exp Toxicol, 30(9), 1174-1180.

Sadeghniiat-Haghighi, K., Bahaedini, L. S., Mehrdad, R., Meysami, A. P., Chavoshi, F., & Soltani, S. (2011). The Relationship Between Blood Pressure and Lead Exposure in Battery Recycling Workers. Journal of Biological Sciences, 11, 454-458.

Safar, M. E. (1989). Pulse pressure in essential hypertension: clinical and therapeutical implications. J Hypertens, 7(10), 769-776.

Safar, M. E., Levy, B. I., & Struijker-Boudier, H. (2003). Current perspectives on arterial stiffness and pulse pressure in hypertension and cardiovascular diseases. Circulation, 107(22), 2864-2869.

Salignac, P., & Leclerc, D. (2011). En finir avec le saturnisme professionnel: intérêt de la plombémie cumulée. Archives des Maladies Professionnelles et de l'Environnement, 72(3), 256-260.

Schroeder, H. A., & Tipton, I. H. (1968). The human body burden of lead. Archives of Environmental Health: An International Journal, 17(6), 965-978.

Scinicariello, F., Yesupriya, A., Chang, M.-h., & Fowler, B. A. (2010). Modification by ALAD of the association between blood lead and blood pressure in the US population: results from the Third National Health and Nutrition Examination Survey. Environ Health Perspect, 118(2), 259.

Staessen, J. A., Lauwerys, R. R., Buchet, J. P., Bulpitt, C. J., Rondia, D., Vanrenterghem, Y., & Amery, A. (1992). Impairment of renal function with increasing blood lead concentrations in the general population. New England journal of medicine, 327(3), 151-156.

Stohs, S. J., & Bagchi, D. (1995). Oxidative mechanisms in the toxicity of metal ions. Free radical biology and medicine, 18(2), 321-336.

Telisman, S., Pizent, A., Jurasović, J., & Cvitković, P. (2004). Lead effect on blood pressure in moderately lead-exposed male workers. Am J Ind Med., 45(5), 446-454.

Tepper, A., Mueller, C., Singal, M., & Sagar, K. (2001). Blood pressure, left ventricular mass, and lead exposure in battery manufacturing workers. Am J Ind Med., 40(1), 63-72.

Van Bortel, L. M., Struijker-Boudier, H. A., & Safar, M. E. (2001). Pulse pressure, arterial stiffness, and drug treatment of hypertension. Hypertension, 38(4), 914-921.

Vaziri, N., Ding, Y., & Ni, Z. (2001). Compensatory up-regulation of nitric-oxide synthase isoforms in lead-induced hypertension; reversal by a superoxide dismutase-mimetic drug. Journal of Pharmacology and Experimental Therapeutics, 298(2), 679-685.

Wu, T. N., Shen, C. Y., Ko, K. N., Guu, C. F., Gau, H. J., Lai, J. S., . . . Chang, P. Y. (1996). Occupational lead exposure and blood pressure. Int J Epidemiol, 25(4), 791-796.

Zeqiri, N., Zeqiri, S., & Skenderaj, S. (2012). Blood pressure evaluation at the workers exposed to lead. Med Arh, 66(2), 92-93.