Table 1: Findings from hypertension and chronic exposure to arsenic studies.

ReferenceStudy design and sample sizeLocation and populationExposure assessmentOutcome assessmentVariables adjusted forFindings
Exposure categoriesPrevalenceOdds ratios
(95% CI)

Chen et al. [19]Cross-sectional: 382 men and 516 women of age over 30 and residing in arseniasis hyperendemic villages of Taiwan
Exposed: 779 (drunk artesian well for some time)
Unexposed: 119 (never used artesian well)
TaiwanLong-term arsenic exposure calculated, structured questionnaire, and measured arsenic concentration in well water
Cumulative arsenic exposure index was used
WHO protocol: Systolic blood pressure ≥160 mm Hg, Diastolic blood pressure ≥95 mm Hg
AND/OR history of hypertension regularly treated with antihypertensive drugs
Age, sex, body mass index, fasting serum triglyceride levels, diabetes mellitus, proteinuria0 years
1–10 years
11–20 years
21–30 years
>30 years
0 μg/L
10–700 μg/L
710–900 μg/L
>900 μg/L
Unknown
0 μg/L-years
100–6300 μg/L years
6400–10800 μg/L-years
10900–14700 μg/L-years
14800–18500 μg/L-years
>18500 μg/L-years
Unknown
Case: 5.0%
Case: 3.8%
Case: 15.4%
Case: 24.7%
Case: 27.7%
Case: 5.0%
Case: 20.0%
Case: 28.8%
Case: 19.2%
Case: 17.0%
Case: 5.0%
Case: 4.9%
Case: 12.8%
Case: 22.1%
Case: 26.5%
Case: 29.2%
Case: 17.0%
1.0
1.1 (0.2–4.6)
3.2 (1.2–8.2)
3.0 (1.2–7.3)
1.9 (0.7–6.0)
1.0
2.5 (1.0–6.2)
3.6 (1.4–9.1)
2.6 (1.0–6.9)*
1.7 (0.7–4.6)
1.0
0.9 (0.2–3.3)
2.4 (0.8–6.9)
3.6 (1.4–9.6)
3.6 (1.4–9.3)
2.8 (1.1–7.1)*
1.7 (0.7–4.6)

Rahman et al. [21]Cross-sectional: 1595 residents 30 years or older
Exposed: 1481 (had a history of arsenic-contaminated drinking water)
Unexposed: 114 (had no history of arsenic-contaminated drinking water)
BangladeshArsenic concentration measured in artesian well water and consumption was assessed by structured questionnaire to estimate time-weighted mean arsenic levels (mg/L) for each subjectSystolic blood pressure ≥140 mm Hg,
AND
diastolic blood pressure ≥90 mm Hg
Age, sex, body mass indexUnexposed
<500 μg/L
500–1000 μg/L
>1000 μg/L
Unexposed
<1000 μg/L
1000–5000 μg/L
5000–10000 μg/L
>10000 μg/L
Case: 7.9%
Case: 8.0%
Case: 16.1%
Case: 19.5%
Case: 7.9%
Case: 5.5%
Case: 12.0%
Case: 14.3%
Case: 22.9%
1.0
1.2 (0.6–2.3)
2.2 (1.1–4.3)
2.5 (1.2–4.9)*
1.0
0.8 (0.3–1.7)
1.5 (0.7–2.9)
2.2 (1.1–4.4)
3.0 (1.5–5.8)*
Dose response among exposed 𝑃 value <0.001

Zieroldet al. [18]Cross-sectional: 1185 residents from Wisconsin, USA, who are 35 years or older and were drinking from private well water supply for 20 or more years
Exposed: 40 (>2 μg/L)
Unexposed: 34 (<2 μg/L)
Wisconsin, USAQuestionnaire survey for life-time history, usual drinking water consumption, use of water-treatment systems and family health history. Length of exposure estimated between July 2000 and January 2002Self-reportedGender, age, smoking status, body mass index<2 μg/L
2 μg/L–10 μg/L
>10 μg/L
1.0
1.2 (0.8–1.6)
1.7 (1.1–2.5)*

Wang et al. [5]Prospective cohort: 18940 residents 40 years or older followed up for an average of 12 years
Exposed: 2264 (residents from arsenic-exposed areas and drinking from tube wells)
Unexposed: 16676 (residents from unexposed areas and drinking from tap water)
TaiwanIn one area, median arsenic concentration of the shared artesian well was used as exposure, whereas, in other area, the exposure was the arsenic level in the participants’ own tube wells. People using tap water or drinking water with <10 μg/L of arsenic were considered unexposed.Systolic blood pressure ≥160 mm Hg,
diastolic blood pressure ≥95 mm Hg,
OR
history of hypertension regularly treated with antihypertensive agents
Age, gender<10 μg/L
10–49 μg/L
50–499 μg/L
>500 μg/L
Case: 8.1%
Case: 22.0%
1.0
2.4 (2.1–2.7)*

Chen [25]Cross-sectional: 11,458 men and women from Bangladesh who are 18 years or olderBangladeshSystolic blood pressure ≥140 mm Hg
Diastolic blood pressure ≥90 mm Hg
Systolic blood pressure ≥140 mm Hg
AND/OR
Diastolic blood pressure ≥90 mm Hg
Pulse pressure ≥55 mm Hg
Age, gender, body mass index, cigarette smoking status, education length0.1–7.0
7.3–39.0
40.0–91.0
92.0–179.0
180.0–864.0
0.1–7.0
7.3–39.0
40.0–91.0
92.0–179.0
180.0–864.0
0.1–7.0
7.3–39.0
40.0–91.0
92.0–179.0
180.0–864.0
0.1–7.0
7.3–39.0
40.0–91.0
92.0–179.0
180.0–864.0
<48.1
48.1–227.8
227.9–585.8
585.9–1494.0
>1494.1
<48.1
48.1–227.8
227.9–585.8
585.9–1494.0
>1494.1
<48.1
48.1–227.8
227.9–585.8
585.9–1494.0
>1494.1
<48.1
48.1–227.8
227.9–585.8
Case: 6.7%
Case: 9.3%
Case: 7.7%
Case: 8.1%
Case: 7.7%
Case: 9.1%
Case: 9.9%
Case: 8.9%
Case: 8.7%
Case: 8.8%
Case: 11.9%
Case: 13.8%
Case: 12.0%
Case: 12.1%
Case: 12.2%
Case: 9.0%
Case: 11.4%
Case: 11.0%
Case: 10.4%
Case: 10.6%
Case: 7.2%
Case: 8.2%
Case: 8.1%
Case: 8.3%
Case: 8.0%
Case: 10.2%
Case: 8.5%
Case: 9.1%
Case: 9.0%
Case: 8.9%
Case: 13.2%
Case: 11.9%
Case: 12.3%
Case: 12.8%
Case: 12.3%
Case: 9.1%
Case: 11.6%
Case: 10.8%
1.0
1.50 (1.20–1.88)
1.24 (0.99–1.57)
1.32 (1.05–1.66)
1.25 (0.99–1.57)
1.0
1.15 (0.94–1.41)
1.05 (0.85–1.29)
1.02 (0.83–1.26)
1.07 (0.87–1.31)
1.0
1.24 (1.04–1.49)
1.07 (0.89–1.29)
1.08 (0.90–1.30)
1.11 (0.92–1.33)*
1.00
1.33 (1.10–1.62)
1.27 (1.04–1.55)
1.19 (0.98–1.45)
1.20 (0.99–1.47)
1.00
1.19 (0.95–1.50)
1.28 (1.01–1.61)
1.26 (1.00–1.58)
1.15 (0.92–1.45)
1.00
0.84 (0.68–1.04)
0.96 (0.78–1.18)
0.93 (0.75–1.14) 0.91 (0.74–1.14)
1.00
0.91 (0.75–1.09)
0.99 (0.82–1.19)
1.01 (0.84–1.21)
0.95 (0.79–1.14)*
1.00
1.32 (1.10–1.62)
1.27 (1.04–1.55)

Chen [25]Cross-sectional: 11,458 men and women from Bangladesh who are 18 years or olderBangladeshSystolic blood pressure ≥140 mm Hg
Diastolic blood pressure ≥90 mm Hg
Systolic blood pressure ≥140 mm Hg
and/OR
Diastolic blood pressure ≥90 mm Hg
Pulse pressure ≥55 mm Hg
Age, gender, body mass index, cigarette smoking status, education length585.9–1494.0
>1494.1
≤90.0
90.1–159.2
159.3–245.9
246.0–405.4
>405.4
≤90.0
90.1–159.2
159.3–245.9
246.0–405.4
>405.4
≤90.0
90.1–159.2
159.3–245.9
246.0–405.4
>405.4
≤90.0
90.1–159.2
159.3–245.9
246.0–405.4
>405.4
Case: 11.2%
Case: 10.1%
Case: 8.3%
Case: 8.6%
Case: 8.0%
Case: 7.5%
Case: 6.6%
Case: 10.7%
Case: 9.9%
Case: 9.4%
Case: 7.7%
Case: 7.7%
Case: 14.0%
Case: 13.6%
Case: 12.4%
Case: 11.1%
Case: 10.6%
Case: 10.1%
Case: 10.7%
Case: 10.9%
Case: 10.1%
Case: 10.1%
1.19 (0.98–1.45)
1.20 (0.99–1.47)
1.00
1.14 (0.91–1.42)
1.12 (0.90–1.41)
1.11 (0.89–1.40)
1.09 (0.86–1.39)
1.00
1.00 (0.82–1.23)
1.06 (0.86–1.30)
0.87 (0.70–1.08)
0.99 (0.80–1.24)
1.00
1.04 (0.87–1.24)
1.02 (0.85–1.22)
0.93 (0.77–1.12)
0.99 (0.82–1.20)
1.00
1.07 (0.88–1.31)
1.10 (0.91–1.34)
1.05 (0.86–1.58)
1.09 (0.89–1.34)

Huang et al. [20]Cross-sectional: 488 women and 383 men southwestern coast of Taiwan whose age is 30 years or olderTaiwanPercentage of inorganic arsenic in urine was used to determine exposureWHO protocol: Systolic blood pressure ≥140 mm Hg, Diastolic blood pressure ≥90 mm Hg, AND/OR history of hypertension regularly treated with antihypertensive drugsAge, gender, body mass index, cigarette smoke, alcohol consumption, triglyceride level, cumulative arsenic exposure *InAs%
<4.53%
4.53%–8.00%
≥8.00%
CAE = 0 μg/L-year
InAs%**
<61000
≥61000
CAE > 0 μg/L
InAs%
<61000%
≥61000
Case: 37.3%
Case: 30.6%
Case: 41.2%
Case: 21.3%
Case: 22.0%
Case: 38.6%
Case: 56.5%
1.0
0.72 (0.46–1.11)
1.21 (0.79–1.85)
𝑃 for trend 𝑃 -value: 0.35
1.0
1.04 (0.43–2.48)
2.31 (1.19–4.48)*
2.84 (1.47–5.46)*
* 𝑃 < 0 . 0 5
** 𝑃 < 0 . 0 1

Chen et al. [6]Cross-sectional: 10,910 participants from Bangladesh who are married, 18 years or older, and have had resided in the area for at least 5 yearsBangladeshArsenic concentration was measured in the wells to estimate time-weighted well arsenic concentration (TWA) combining the water use behaviour for, an average, last 10 years for men and 8.3 years for womenOverall population: Systolic hypertension ≥140 mm Hg
Diastolic blood pressure ≥90 mm Hg
Systolic hypertension ≥140 mm Hg
AND/OR
Diastolic blood pressure ≥90 mm Hg
Pulse blood pressure ≥55 mm Hg
Age, gender, body mass index, cigarette smoking status, education length, daily water consumption(Mean years exposed)
0.1 μg/L–8.0 μg/L
(2.8 years)
8.1 μg/L–40.8 μg/L
(23.2 years)
40.9 μg/L–91.0 μg/L
(63.9 years)
91.1 μg/L–176.0 μg/L
(128.1 years)
176.1 μg/L–864.0 μg/L
(283.1 years)
0.1 μg/L–8.0 μg/L
(2.8 years)
8.1 μg/L–40.8 μg/L
(23.2 years)
40.9 μg/L–91.0 μg/L
(63.9 years)
91.1 μg/L–176.0 μg/L
(128.1 years)
176.1 μg/L–864.0 μg/L
(283.1 years)
0.1 μg/L–8.0 μg/L
(2.8 years)
8.1 μg/L–40.8 μg/L
(23.2 years)
40.9 μg/L–91.0 μg/L
(63.9 years)
91.1 μg/L–176.0 μg/L
(128.1 years)
176.1 μg/L–864.0 μg/L
(283.1 years)
0.1 μg/L–8.0 μg/L
(2.8 years)
8.1 μg/L–40.8 μg/L
(23.2 years)
40.9 μg/L–91.0 μg/L
(63.9 years)
91.1 μg/L–176.0 μg/L
(128.1 years)
176.1 μg/L–864.0 μg/L
(283.1 years)
Case: 7.3%
Case: 8.9%
Case: 8.0%
Case: 8.2%
Case: 7.6%
Case: 10.0%
Case: 8.9%
Case: 9.4%
Case: 8.5%
Case: 8.8%
Case: 12.9%
Case: 12.9%
Case: 12.5%
Case: 11.9%
Case: 12.1%
Case: 9.1%
Case: 11.9%
Case: 10.6%
Case: 10.4%
Case: 10.7%
1.00
1.39 (1.10–1.75)
1.21 (0.96–1.54)
1.28 (1.01–1.62)
1.13 (0.90–1.44)
1.00
0.96 (0.77–1.2)
1.01 (0.81–1.25)
0.93 (0.75–1.16)
0.97 (0.78–1.2)
1.00
1.1 (0.90–1.33)
1.03 (0.85–1.25)
1.01 (0.83–1.22)
1.02 (0.84–1.23)*
1.00
1.39 (1.14–1.71)
1.21 (0.99–1.49)
1.19 (0.97–1.45)
1.19 (0.97–1.46)

Chen et al. [6]Cross-sectional: 10,910 participants from Bangladesh who are married, 18 years or older, and have had resided in the area for at least 5 yearsBangladeshSubpopulation (≥5 years exposure):
Systolic hypertension ≥140 mm Hg
Diastolic blood pressure ≥90 mm Hg
Systolic hypertension ≥140 mm Hg
AND/OR
Diastolic blood pressure ≥90 mm Hg
Pulse blood pressure ≥55 mm Hg
Age, gender, body mass index, cigarette smoking status, education length, daily water consumption(Mean years exposed)
0.1 μg/L–8.0 μg/L
(2.7 years)
8.1 μg/L–40.8 μg/L
(23.2 years)
40.9 μg/L–91.0 μg/L
(64.3 years)
91.1 μg/L–176.0 μg/L
(127.2 years)
176.1 μg/L–864.0 μg/L
(284.7 years)
0.1 μg/L–8.0 μg/L
(2.7 years)
8.1 μg/L–40.8 μg/L
(23.2 years)
40.9 μg/L–91.0 μg/L
(64.3 years)
91.1 μg/L–176.0 μg/L
(127.2 years)
176.1 μg/L–864.0 μg/L
(284.7 years)
0.1 μg/L–8.0 μg/L
(2.7 years)
8.1 μg/L–40.8 μg/L
(23.2 years)
40.9 μg/L–91.0 μg/L
(64.3 years)
91.1 μg/L–176.0 μg/L
(127.2 years)
176.1 μg/L–864.0 μg/L
(284.7 years)
0.1 μg/L–8.0 μg/L
(2.7 years)
8.1 μg/L–40.8 μg/L
(23.2 years)
40.9 μg/L–91.0 μg/L
(64.3 years)
91.1 μg/L–176.0 μg/L
(127.2 years)
176.1 μg/L–864.0 μg/L
(284.7 years)
Case: 7.6%
Case: 9.0%
Case: 8.9%
Case: 8.4%
Case: 7.7%
Case: 10.2%
Case: 8.8%
Case: 10.2%
Case: 8.4%
Case: 9.1%
Case: 12.9%
Case: 12.6%
Case: 13.7%
Case: 12.0%
Case: 12.5%
Case: 8.7%
Case: 11.9%
Case: 11.1%
Case: 10.9%
Case: 10.5%
1.35 (1.02–1.77)
1.28 (0.97–1.69)
1.3 (0.99–1.72)
1.12 (0.85–1.47)
1.00
0.94 (0.72–1.22)
1.07 (0.83–1.38)
0.93 (0.72–1.20)
1.00 (0.78–1.28)
1.00
1.06 (0.84–1.34)
1.12 (0.89–1.41)
1.03 (0.82–1.30)
1.05 (0.84–1.31)
1.00
1.5 (1.16–1.91)
1.34 (1.04–1.73)
1.35 (1.05–.71)
1.24 (0.97–1.59)

Jones et al. [22]Prospective cohort: 4167 adults (men) of age 20 years or older who participated in the survey from 2003 to 2008USATotal arsenic concentration (μg/L) in urine was used as exposure levelOverall population:
Systolic hypertension ≥140 mm Hg
Diastolic blood pressure ≥90 mm Hg
Sex, age, race/ethnicity, education, BMI, smoking status, continine, serum folate, vitamin12, diabetes, and alcohol consumptionTotal arsenic (μg/L) <4.24.2–8.3 >8.3–17.1>17.1
Model 2 1.03 (0.96–1.10)1.001.09 (0.84–1.41) 1.33 (0.99–1.80)  1.22 (0.91–1.64)*
Total arsenic minus arsenobetaine ((μg/L)
<3.13.1–5.8>5.8–10.8>10.8
Model 21.05 (0.96–1.14)1.001.07 (0.81–1.42)1.34 (0.95–1.89)  1.30 (092–1.83)
Dimethylarsinate ((μg/L)
<2.02.0–3.6>3.6–6.0>6.0
Model 21.12 (1.01–1.23)1.001.06 (0.80–1.41)1.21 (0.89–1.64)  1.29 (0.93–1.79)

*OR included in the meta-analysis.
** PMI: primary methylation index, InAs.