AUTHOR=Xiao Fang , An Ziwen , Lv Junli , Sun Xiaoyi , Sun Heming , Liu Yi , Liu Xuehui , Guo Huicai TITLE=Association between per- and polyfluoroalkyl substances and risk of hypertension: a systematic review and meta-analysis JOURNAL=Frontiers in Public Health VOLUME=Volume 11 - 2023 YEAR=2023 URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2023.1173101 DOI=10.3389/fpubh.2023.1173101 ISSN=2296-2565 ABSTRACT=Background: Existing evidence indicated that per- and polyfluoroalkyl substances (PFASs) exposure might increase the risk of hypertension, but the findings were discordant. So, we aimed to explore the relationship between PFASs and hypertension by this systematic review and meta-analysis. Methods: We searched PubMed, Embase, and the Web of Science for research published in English that examined the relationship between PFASs and hypertension before August 13, 2022. The random effect model was used to aggregate the evaluation by Stata 15.0 for windows. We also conducted subgroup analyses by region and hypertension definition. Besides, a sensitivity analysis was carried to detect the robustness of the finding. 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 greater levels of PFOS, PFOA, and PFHxS are correlated with an increased risk of hypertension. However, further high-quality population research and pathophysiology investigations are required to shed light on the possible mechanism and demonstrate causation because of the considerable variability.