Persistent Organic Pollutants, Hormones and Hypertension in Hispanic/Latino Adults: The HCHS/SOL Study

There is an upward trend in the incidence of hypertension which may be causally linked to persistent organic pollutants (POPs) exposure and hormone dysregulation. Acculturation may also play an important role in hormone dysregulation. This dissertation comprised 2,264 adults aged 45-74 years from the Hispanic Community Health Study/Study of Latinos and examined the relationship of POPs exposure, thyroid and sex hormones with transition to prehypertension and hypertension and change in blood pressure (BP) after 6 years of follow-up. We also assessed associations of acculturation and Hispanic/Latino background with hormones. Organochlorine pesticides (OCPs) were associated with transition to prehypertension while both polychlorinated biphenyls and OCPs were associated with transition to hypertension from normotension and prehypertension and with change in BP. In both men and postmenopausal women, we found positive associations of triiodothyronine with change in pulse pressure and transition to hypertension from prehypertension and normotension. Thyroid stimulating hormone was positively associated with transition to hypertension in men and change in diastolic BP in both sexes. We found that sex hormones may operate differently by stage of high BP in both sexes. Dehydroepiandrosterone sulfate was inversely associated with transitioning from normotension to prehypertension in both sexes and with transitioning from prehypertension to hypertension in women. Low estradiol was protective of transitioning to hypertension from prehypertension in women, bioavailable testosterone (T) and T were associated with transitioning from normotension to prehypertension in men while estradiol was protective. Follicle stimulating hormone (FSH), luteinizing hormone (LH), and LH/T ratio were protective of transitioning to hypertension while LH/FSH ratio was positively associated with transitioning to hypertension. Additionally, we found significant differences in hormones by Hispanic/Latino background. Language but not social acculturation, age at immigration, dietary acculturation, and acculturation score from the Multi-Ethnic Study of Atherosclerosis were selectively associated with sex and thyroid hormones in both sexes. Current smoking and sleep apnea syndrome were partial mediators of the relationship between Hispanic/Latino background and triiodothyronine. This dissertation provides a better understanding of the complex multifactorial disease etiology of hypertension. Public health interventions should incorporate early and regular BP monitoring, treatment and education on hypertension prevention and control.