Hypertension incidence after tap-water implementation: a 13-year follow-up study in the arseniasis-endemic area of southwestern Taiwan

Hypertension is the leading cause of cardiovascular disease worldwide. Long-term arsenic exposure has been linked to increased risk for hypertension; however, little is known whether a previous exposure has lingering effects on hypertension after the exposure being reduced significantly for decades. The study cohort was established in 1990 in an arseniasis-endemic area of 3 villages — Homei, Fuhsin, and Hsinming in Putai Township located on the southwestern coast of Taiwan, where residents were exposed to artesian well water (median level = 700 to 930 μg/L) until early 1970s. The original cohort consisted of 490 non-hypertensive residents over 30-yrs-old and 352 of them were successfully followed up in 2002/03. Arsenic concentrations in the artesian well water consumed by residents during 1960s were used to indicate the previous exposure while urinary arsenic species measured in 2002/3 was used to represent current exposure. Hypertension incidences were 27.4, 65.6, and 69.1, per 1000 person-years for men aged 35-49, 50-64, and 65-74 years, respectively being higher than the corresponding rates of 25.1, 46.1, and 57.2 in a community-based longitudinal study. Cancer was the major cause of the total deaths (17/30 = 57%). Diastolic blood pressure was shown to increase with an increased cumulative arsenic ingestion from drinking water (β = 0.27, p < 0.001). The incidence was increased by 2.43-fold in subjects of As(V) ≥ 2.67 μg/g creatinine as compared to those of As(V) < 1.20 μg/g creatinine (the third vs. first tertile; p = 0.047) after adjustment for conventional risk factors. This study suggests that three decades after cessation of drinking artesian well water, residents of the endemic area are still at increased risk for developing hypertension, particularly those who excrete high amounts of As(V).