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In Reply: Dr Hense points out that many factors play a role in hypertension. A major issue in previous studies of blood lead concentration and blood pressure has been whether to control for hemoglobin level, which appears to be an established determinant of blood lead concentration, but whose relationship to blood pressure has not been clearly established.¹ However, consideration of hemoglobin is complicated by the fact that lead is known to decrease hemoglobin levels, presumably through inhibition of biosynthesis of heme.² Thus, to enter hemoglobin into the regression model may in fact introduce problems of adjustment for factors along the causal pathway between lead exposure and its effect on blood pressure, or even colinearity.

Furthermore, among perimenopausal and postmenopausal women, blood lead levels reflect lead liberated from endogenous sources (bone). Although most of the lead circulating in whole blood is bound to hemoglobin, lead liberated from bone results in a . . . [Full Text of this Article]

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