Per-and Polyfluoroalkyl Substances (PFAS) and Incident Hypertension in Multi-Racial/Ethnic Women: The Study of Women’s Health Across the Nation

By Ning Ding, Carrie A. Karvonen-Gutierrez, Bhramar Mukherjee, Antonia M. Calafat, Siobán D. Harlow, and Sung Kyun Park
June 13, 2022
DOI: 10.1161/HYPERTENSIONAHA.121.18809


Perfluoroalkyl and polyfluoroalkyl substances (PFAS) are ubiquitous synthetic chemicals that may disrupt blood pressure controls; however, human evidence to support this hypothesis is scant. We examined the association between serum concentrations of PFAS and risks of developing hypertension.


This study included 1058 midlife women initially free of hypertension from the multiracial and multiethnic SWAN (Study of Women’s Health Across the Nation) with annual follow-up visits between 1999 and 2017. Hypertension was defined as blood pressure ≥140 mm Hg systolic or ≥90 mm Hg diastolic or receiving antihypertensive treatment. Cox proportional hazards models were utilized to calculate hazard ratios and 95% CIs. Quantile g-computation was implemented to evaluate the joint effect of PFAS mixtures.


During 11 722 person-years of follow-up, 470 participants developed incident hypertension (40.1 cases per 1000 person-years). Compared with the lowest tertile, women in the highest tertile of baseline serum concentrations had adjusted hazard ratios of 1.42 (95% CI, 1.19–1.68) for perfluorooctane sulfonate (P trend=0.01), 1.47 (95% CI, 1.24–1.75) for linear perfluorooctanoate (P trend=0.01), and 1.42 (95% CI, 1.19–1.70) for 2-(N-ethyl-perfluorooctane sulfonamido) acetate (P trend=0.01). No significant associations were observed for perfluorononanoate and perfluorohexane sulfonate. In the mixture analysis, women in the highest tertile of overall PFAS concentrations had a hazard ratio of 1.71 (95% CI, 1.15–2.54; P trend=0.008), compared with those in the lowest tertile.


Several PFAS showed positive associations with incident hypertension. These findings suggest that PFAS might be an underappreciated contributing factor to women’s cardiovascular disease risk.


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