Mojtaba Davoudi1,2, Fateme Barjasteh-Askari3,4,5, Mohammad Sarmadi3,4, Mohammad Ghorbani4,6, Mehdi Yaseri7, Edris Bazrafshan3,4, Amir Hossein Mahvi8,9, Mohsen Moohebati10,11. 1. Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. 2. Department of Environmental Health Engineering, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran. 3. Department of Environmental Health Engineering, School of Health, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran. 4. Health Sciences Research Center, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran. 5. Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, PourSina St., Enghelab St., Tehran, 1417613151, Iran. 6. Department of Public Health, School of Health, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran. 7. Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. 8. Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, PourSina St., Enghelab St., Tehran, 1417613151, Iran. Ahmahvi@yahoo.com. 9. Center for Solid Waste Research, Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, Iran. Ahmahvi@yahoo.com. 10. Atherosclerosis Research Center, Avicenna Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran. 11. Department of Cardiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Abstract
BACKGROUND AND OBJECTIVE: Previous studies showed controversial results of the relationship between fluoride exposure through drinking water and elevated blood pressure. We conducted a systematic review and meta-analysis to assess the direct relationship of drinking water fluoride exposure with blood pressure and essential hypertension prevalence in general populations. METHODS: We conducted a systematic search in databases including Web of Knowledge, PubMed, Scopus, and Embase by MeSH and non-MeSH terms for relevant studies with any design published until August 2019, with no limitation in time and language. The pooled effect measure was calculated within a 95% confidence interval (CI). RESULTS: Our search retrieved 630 journal articles, six of which were eligible for data extraction. The random-effects model found significantly higher systolic blood pressure (mean difference = 6.49 mmHg; 95% CI 3.73-9.25; p value < 0.01) and diastolic blood pressure (mean difference = 4.33 mmHg; 95% CI 1.39-7.26; p value < 0.01) in groups exposed to high-fluoride drinking water than in groups exposed to normal/low-fluoride drinking water. A significant relationship was also found between high-fluoride drinking water and essential hypertension (odds ratio = 2.14; 95% CI 1.02-4.49; p value = 0.045). CONCLUSION: The risk of elevated blood pressure increases in the general population of fluoride endemic areas. However, more research is needed to make a firm conclusion about the adverse effects of excess fluoride intake on the cardiovascular system at the individual level.
BACKGROUND AND OBJECTIVE: Previous studies showed controversial results of the relationship between fluoride exposure through drinking water and elevated blood pressure. We conducted a systematic review and meta-analysis to assess the direct relationship of drinking waterfluoride exposure with blood pressure and essential hypertension prevalence in general populations. METHODS: We conducted a systematic search in databases including Web of Knowledge, PubMed, Scopus, and Embase by MeSH and non-MeSH terms for relevant studies with any design published until August 2019, with no limitation in time and language. The pooled effect measure was calculated within a 95% confidence interval (CI). RESULTS: Our search retrieved 630 journal articles, six of which were eligible for data extraction. The random-effects model found significantly higher systolic blood pressure (mean difference = 6.49 mmHg; 95% CI 3.73-9.25; p value < 0.01) and diastolic blood pressure (mean difference = 4.33 mmHg; 95% CI 1.39-7.26; p value < 0.01) in groups exposed to high-fluoride drinking water than in groups exposed to normal/low-fluoride drinking water. A significant relationship was also found between high-fluoride drinking water and essential hypertension (odds ratio = 2.14; 95% CI 1.02-4.49; p value = 0.045). CONCLUSION: The risk of elevated blood pressure increases in the general population of fluoride endemic areas. However, more research is needed to make a firm conclusion about the adverse effects of excess fluoride intake on the cardiovascular system at the individual level.