Assessing effects of PFAS exposure from drinking water on hypertension and blood pressure among adults and children using measured and historically reconstructed PFAS blood levels

The National Institute of Environmental Health Sciences awarded Silent Spring Institute, Inc., $154,700 on August 28, 2026, under the NIEHS Superfund Hazardous Substances Basic Research and Education program (CFDA 93.143) to assess associations between per- and polyfluoroalkyl substance (PFAS) exposure from drinking water and hypertension and blood pressure among adults and children.

The project will analyze measured and historically reconstructed serum PFAS concentrations in relation to blood pressure and hypertension outcomes using data from the Agency for Toxic Substances and Disease Registry Multi-Site PFAS Health Study, which encompasses 6,240 adults and 883 children ages 4–17 from communities in eight states with documented PFAS drinking water contamination. Participants provided blood samples, body measurements, and questionnaire responses during 2019–2023. The study will examine effect modification by age, sex, body mass index, and diet, and will assess PFAS mixture effects across varying exposure trajectories over time to address gaps in evidence surrounding PFAS and cardiovascular health outcomes in both adult and pediatric populations.

Work is performed in Newtonville, Massachusetts. The period of performance runs from August 28, 2026, through August 27, 2028.

Abstract

Hypertension is a leading cause of cardiovascular disease (CVD) and death globally, affecting nearly 50% of adults in the U.S. And over 1 billion adults worldwide. Annual healthcare costs associated with hypertension are approximately $131 billion in the U.S. The global prevalence of hypertension among children under 18 has increased ~75% from 2000-2015, and hypertension in childhood or adolescence is an important predictor of future CVD and CVD mortality. In addition to well-established risk factors such as poor diet, sodium intake, alcohol consumption, obesity, and lack of physical activity, emerging evidence suggests that exposure to per- and polyfluoroalkyl substances (PFAS) may contribute to hypertension and increased blood pressure in adults and children. However, there are important gaps in the evidence still to address including the importance of quantifying the impact of PFAS mixtures in adults and children and effects of varying exposures over time. Our proposed project will fill these gaps by assessing associations of measured and historically reconstructed serum PFAS concentrations with blood pressure and hypertension among adults and children. We will efficiently build upon data already collected as part of the agency for toxic substances and disease registry (ATSDR) multi- site PFAS health study (MSS), which includes 6,240 adults and 883 children (ages 4-17) from communities in eight states with a history of PFAS drinking water contamination. This study will be one of the largest and most comprehensive epidemiological studies to date and has sufficient statistical power to examine effect modification by age, SEX, body mass index, and diet. Participants provided blood samples and completed body measurements and questionnaires in 2019-2023. Our preliminary results showed associations between measured serum concentrations and increased systolic and diastolic blood pressure among adult participants. We will extend these findings by applying novel study design and statistical methods and, for the first time, time series of historically reconstructed serum PFAS concentrations for adults (back to 2000) and children (back to birth) to assess impacts of PFAS, individually and in mixtures, on blood pressure and hypertension, as well as the influence of the timing of these exposures. We will meet these objectives through two closely related aims: aim 1. Examine associations of historically reconstructed serum PFAS concentrations with blood pressure and hypertension among adults. Aim 2. Examine associations of historically reconstructed and measured serum PFAS concentrations with blood pressure and hypertension among children. Impact: this project will efficiently leverage existing cohorts and address two major gaps in our current understanding of associations between PFAS exposure to blood pressure and hypertension among adults and children. Findings from this study emphasize the importance of reducing PFAS exposure from drinking water and other sources to improve the overall cardiovascular health for both adults and children and can inform future targeted interventions to reduce the risk of high blood pressure, especially in highly exposed communities.