Association Between Polychlorinated Biphenyls and Hypertension Risk: A Systematic

Seyedeh Fatemeh Hamzavi ¹ Iman Elahi Vahed ¹ Ali Samadi Shams ² Fateme Nozari ³ Baroukh Gamzeh Latava ⁴ Saman Mardukhi ⁵ Behnoosh Sabaghi ⁶ Zakieh Sadat Hosseini ⁷ Zohre Masoumi Shahr-e Babak ¹ Sahar Ahrari ⁸ Ali Keshavarzian ⁹ Mohammad Rahmanian ^1*

• ¹ Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Alborz, Iran
• ² Islamic Azad University, Tabriz, Tabriz, Iran
• ³ Tehran University of Medical Sciences, Tehran, Tehran, Iran
• ⁴ School of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
• ⁵ Occupational Health Engineering, School of Health Sciences, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
• ⁶ Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Isfahan, Iran
• ⁷ Neyshabur University of Medical Sciences, Neyshabur, Iran
• ⁸ Pharmaceutical Sciences Branch, Islamic Azad University, Tehran, Alborz, Iran
• ⁹ Golestan University of Medical Sciences, Gorgan, Golestan, Iran

Background and Aim: Hypertension (HTN) is a widespread global health challenge, and its increasing prevalence is attributed to individual and environmental risk factors. Persistent organic pollutants (POPs), especially polychlorinated biphenyls (PCBs), contribute to cardiovascular risk by accumulating in fatty tissues, which leads to oxidative stress and vascular inflammation. This review and meta-analysis aimed to investigate the association between PCB exposure and hypertension.Methods: Adhering to the PRISMA 2020 guidelines, data sources such as PubMed, Scopus, Web of Science, and Google Scholar were systematically searched up to July 2024 to find observational studies on the link between PCBs and hypertension risk. Studies were reviewed and chosen according to established inclusion and exclusion criteria, focusing on observational studies examining PCB exposure and hypertension risk. Independent reviewers conducted data extraction, and the quality of studies was evaluated using the JBI critical appraisal tool. A metaanalysis with a random-effects model was conducted to determine combined odds ratios (ORs) for hypertension linked to total PCB exposure and specific PCB types.Of the 494 records identified, 21 studies met the inclusion criteria, comprising 5 cohort studies, 15 cross-sectional studies, and one case-control study, totaling 51,514 participants.Exposure to total PCBs correlated with an elevated risk of hypertension (OR=1.78, 95% CI: 1.30-2.44). Dioxin-like PCBs were also associated with a heightened risk (OR=1.54, 95% CI:1.24-1.90), while non-dioxin-like PCBs were not significantly linked (OR=1.16, 95% CI: 0.81-1.66). Among individual congeners, PCB-74, PCB-118, PCB-105, and PCB-153 were significantly related to higher hypertension risk.These findings indicate a positive correlation between PCB exposure and hypertension, particularly with dioxin-like PCBs and certain PCB congeners. Additional research is necessary to clarify the mechanisms involved and to promote measures for reducing PCB exposure, particularly in high-risk populations.