| Poorly Controlled Hypertension in a Painter with Chronic Lead Toxicity Howard Hu Center for Occupational and Environmental Medicine, Olympus Specialty Hospital; Braintree, Massachusetts, USA; Occupational Health Program, Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA; and Channing Laboratory, Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA Abstract
   Olympus Specialty Hospital,
Harvard School of Public Health, and
Harvard Medical School
In 1984, a 56-year-old house painter developed intractable pain in his back and other joints. After several unrevealing medical work-ups, he was found to have a high blood lead level (122 µg/dL) ; he has a history of scraping and sanding lead paint without adequate protective measures. The patient was hospitalized and chelated with EDTA four times over the next 5 years ; each time he felt better at the end of his treatment, but he returned to largely the same working conditions. He developed hypertension in April 1989, underwent a final chelation, and retired. He was subsequently followed on a regular basis with repeated measurement of lead levels in blood and bone (using a K-x-ray fluorescence instrument) as well as clinical parameters. In 1995 his blood pressure became difficult to control despite a sequential increase in his antihypertensive medication dosages and the addition of new medications. In 1997 he began calcium supplementation and a high-calcium diet ; his blood pressure declined markedly, allowing him to taper off of two of his four antihypertensive medications. This case demonstrates an occupational activity (construction) that has now become the dominant source of lead exposure for U.S. adults, the importance of a good occupational history to suspecting and making a diagnosis, the possible outcomes of chronic lead toxicity, and the importance of preventing further exposure and using proper methods to treat acute toxicity. It also highlights a current major etiologic question, that is, whether and to what degree lead exposure contributes to the development of hypertension, and raises the issue of whether lead-induced hypertension constitutes a subset of hypertension that is especially amenable to therapy with dietary calcium. Key words: blood pressure, dietary calcium, hypertension, K-x-ray fluorescence, lead. Environ Health Perspect 109:95-99 (2001) . [Online 21 December 2000] http://ehpnet1.niehs.nih.gov/docs/2001/109p95-99hu/ abstract.html Address correspondence to H. Hu, Channing Laboratory, 181 Longwood Avenue, Boston, MA 02115 USA. Telephone: (617) 525-2736. Fax: (617) 525-0362. E-mail: howard.hu@channing.harvard.edu I thank the patient, who graciously cooperated in all of the examinations described in this report. I also thank S. Oliveira for his technical assistance. Support for this work was provided by NIEHS ES 05257, NIEHS ES 07821, NIEHS P42-ES05947 Project 1 (with funding from the US EPA) , NIEHS Center Grant 2 P30 ES 00002, and a NIOSH Education and Research Center grant. Received 4 August 2000 ; accepted 19 October 2000.
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