Relationship between lead exposure and different types of hypertension : systematic review and dose-response meta-analysis

Peilin Yang¹Tianyi Ji¹Zhendong Yang¹Jiayuan Song²Hongwei Liu^3*Haixia Fan^4*

• ¹Heilongjiang University of Chinese Medicine, Harbin, China
• ²Changchun University of Chinese Medicine School of Integrated Traditional Chinese and Western Medicine, Changchun, China
• ³The Ninth Clinical Medical College of Shanxi Medical University, shanxi, China
• ⁴First Hospital of Shanxi Medical University, Taiyuan, China

Background : This systematic review and meta-analysis aimed to quantify the association between environmental and occupational lead exposure and the risk of various hypertension subtypes. We further evaluated this relationship through a dose-response analysis to provide a scientific basis for targeted public health interventions. Methods : Observational studies on lead exposure and hypertension were searched from Chinese/English databases (inception to June 9, 2025). Two researchers independently screened studies, extracted data, and assessed bias risk. Random-effects meta-analysis calculated pooled ORs (95% CIs); meta-regression/subgroup analyses explored heterogeneity. Egger's test evaluated publication bias, sensitivity analyses verified result robustness, and dose-response analysis was applied to multi-level exposure data. Result : 24 studies (181,500 participants) were included. Lead exposure correlated significantly with hypertension (pooled OR=1.27, 95% CI:1.20-1.34) with high heterogeneity (I²=91.4%, P<0.001). Stronger associations were found for blood lead (OR=1.32), essential hypertension (OR=1.31), and resistant hypertension (OR=1.36); no significant associations for bone lead or gestational hypertension. Hypertension risk rose sharply at blood lead ≥0.107 μg/dL, reaching OR=4.85 at 8.435 μg/dL. Potential publication bias existed, but sensitivity analyses confirmed robustness. Conclusion : Lead exposure is a hypertension risk factor with a clear dose-response relationship. It is recommended to include blood lead in hypertension risk assessment and set a blood lead action level of < 0.107 μg/dL for high-risk groups to reduce hypertension burden from lead pollution.