Exposure characteristics of legacy and novel per- and polyfluoroalkyl substances in blood and association with hypertension among low-exposure population

The exposure characteristics of per- and polyfluoroalkyl substances (PFAS) in blood and their associations with hypertension have been well investigated in high-exposure populations, yet limited information is available concerning low-exposure populations. We conducted a cross-sectional study in a low-exposure population in China. A total of 394 females, including 162 with hypertension, were recruited and 30 PFAS were measured in whole blood samples. General linear model, generalized additive model, and logistic model were used to identify the associations with hypertension. Additionally, a Bayesian kernel machine regression model was conducted to test the mixture effects. Fourteen PFAS, including two novel species, 6:2 and 8:2 chlorinated polyfluorinated ether sulfonates (Cl-PFESAs), were detected, among which PFOS predominated with the highest median level of 1.47 ng/mL. The median levels of individual PFAS were, however, below the 25th, and even the 5th percentile of previous reports, except for PFHxA, which was above the 50th percentile (median of 0.10 ng/mL). After adjusting for covariates, PFHxA showed a positive association with hypertension (OR=1.54, 95% CI: 1.25, 1.89), while 6:2 Cl-PFESA showed a negative association (OR=0.73, 95% CI: 0.56, 0.95). PFAS didn't show significant mixture effects. We proposed that PFHxA may contribute to hypertension and 6:2 Cl-PFESA may have a hormesis effect.