Background

Hypertension is a leading contributor to global cardiovascular disease burden. Per- and polyfluoroalkyl substances (PFAS) are persistent environmental contaminants widely detected in U.S. adults and have been implicated in cardiovascular dysfunction. However, epidemiologic evidence linking PFAS exposure to hypertension is limited and inconsistent. We therefore examined the association between serum PFAS concentrations and hypertension in a nationally representative sample of U.S. adults.

Methods

We conducted a cross-sectional analysis using data from the 2017–2020 National Health and Nutrition Examination Survey (NHANES), a nationally representative survey of the U.S. population conducted at the Centers for Disease Control and Prevention (CDC). The study included adults aged ≥20 years with complete data on serum PFAS concentrations, blood pressure measurements, and relevant demographic and laboratory covariates.

Results

The analytic sample included 2,551 U.S. adults aged ≥20 years. Perfluorooctane sulfonic acid (PFOS) and perfluorooctanoic acid (PFOA)  were detected in 100% of participants, while perfluorohexane sulfonic acid (PFHxS) and perfluorononanoic acid (PFNA) were detected in 98.4% and 94.8% of participants, respectively. PFAS concentrations varied significantly by age, sex, race/ethnicity, smoking status, income, and body mass index, with higher levels observed among older adults and males (all p < 0.001). Participants with high blood pressure had slightly higher PFOS concentrations than those with normal blood pressure.  In multivariable logistic regression models, serum PFOA concentrations were inversely associated with hypertension (OR = 0.71, 95% CI: 0.55, 0.92), whereas PFOS, PFHxS, and PFNA were not significantly associated with hypertension. Older age, non-Hispanic Black and Asian race/ethnicity, and overweight/obesity were independently associated with higher odds of hypertension.

Conclusion

Our findings suggest that PFAS exposure is nearly universal among U.S. adults. While serum PFOA concentrations were inversely associated with hypertension, no significant associations were observed for other PFAS compounds.