Association between Hypertension and Chronic Arsenic Exposure in Drinking Water: A Cross-Sectional Study in Bangladesh
Abstract
:1. Introduction
2. Methods
2.1. Overview
2.2. Design, Study Area and Population
2.3. Data Collection Procedure
2.4. Exposure Measurement
2.5. Outcome Definition and Measurement
2.6. Other Variables
2.7. Statistical Analysis
3. Results
Overall (n = 1004) | SBP * | DBP * | Pulse blood pressure * | ||||||
---|---|---|---|---|---|---|---|---|---|
No | % | Mean As Conc* (µg/liter, SD) | Mean (mmHg, SD) | Systolic hypertension (SBP, ≥140 mmHg), %Ɨ | Mean (mmHg, SD) | Diastolic hypertension (DBP, ≥90 mmHg),%Ɨ | Mean (mmHg, SD) | High pulse pressure (≥55 mmHg), %Ɨ | |
Gender | |||||||||
Female | 687 | 68.4 | 143.3, ± 185.3 | 110.3, ± 15.9 | 9.8 | 73.1, ± 10.5 | 10.9 | 37.1, ± 8.8 | 3.3 |
Male | 317 | 31.6 | 192.2, ± 220.8 | 114.0, ± 16.4 | 6.7 | 75.3, ± 11.3 | 12.3 | 38.7, ± 9.1 | 5.7 |
Age (years) | |||||||||
30–39 | 405 | 40.3 | 157.5, ± 187.2 | 109.2, ± 13.0 | 2.5 | 72.9, ± 8.6 | 5.4 | 36.4, ± 7.0 | 1 |
40–49 | 263 | 26.2 | 159.5, ± 202.4 | 109.2, ± 15.7 | 5.3 | 72.4, ± 10.8 | 9.5 | 36.8, ± 8.7 | 3 |
50–59 | 156 | 15.6 | 146.5, ± 194.9 | 113.1, ± 16.5 | 10.3 | 74.6, ± 11.8 | 15.4 | 38.5, ± 9.0 | 5.1 |
≥60 | 180 | 17.9 | 171.1, ± 220.2 | 118.3, ± 21.5 | 20.6 | 77.3, ± 13.3 | 23.9 | 41.0, ± 11.9 | 11.7 |
BMI *(tertiles) | |||||||||
<18.22 | 328 | 33 | 202.2, ± 224.7 | 106.8, ± 17.2 | 7 | 70.6, ± 11.2 | 7.6 | 36.1, ± 9.7 | 3.7 |
18.22-21.33 | 333 | 33 | 158.5, ± 195.8 | 111.4, ± 14.8 | 5.4 | 74.0, ± 10.1 | 10.2 | 37.5, ± 8.6 | 4.2 |
>21.33 | 343 | 34 | 117.4, ± 162.7 | 116.0, ± 15.0 | 10.5 | 76.7, ± 10.2 | 16 | 39.3, ± 8.3 | 4.4 |
Education | |||||||||
No education | 694 | 69.1 | 155.4, ± 199.4 | 111.6, ± 17.0 | 9.2 | 73.9, ± 11.3 | 12.5 | 37.8, ± 9.4 | 4.9 |
Primary | 186 | 18.5 | 150.5, ± 179.7 | 111.0, ± 14.6 | 5.4 | 72.9, ± 10.2 | 10.2 | 38.0, ± 8.4 | 2.7 |
Secondary | 124 | 12.4 | 190.0, ± 218.0 | 111.2, ± 12.8 | 2.4 | 74.9, ± 8.2 | 6.4 | 36.3, ± 6.8 | 1.6 |
Religion | |||||||||
Muslim | 766 | 76.3 | 196.3, ± 207.7 | 110.1, ± 15.9 | 6.1 | 73.0, ± 10.5 | 9.9 | 37.2, ± 9.3 | 3.9 |
Hindu | 238 | 23.7 | 37.8, ± 90.2 | 115.7, ± 16.3 | 12.6 | 76.6, ± 11.2 | 16 | 39.2, ± 7.4 | 4.6 |
Marital status | |||||||||
Currently married | 862 | 85.9 | 160.7, ± 201.7 | 111.3, ± 15.6 | 7 | 73.8, ± 10.5 | 10.9 | 37.6, ± 8.7 | 3.7 |
Widowed/divorced | 131 | 13 | 141.5, ± 178.4 | 112.5, ± 19.1 | 12.2 | 74.2, ± 12.4 | 14.5 | 38.3, ± 10.8 | 6.9 |
Never married | 11 | 1.1 | 210.4, ± 167.4 | 110.0, ± 17.6 | 9.1 | 72.5, ± 12.4 | 9.1 | 36.5, ± 7.6 | 0 |
Monthly income | |||||||||
≤50$ (1$ = 80tk) | 537 | 53.5 | 151.0, ± 196.0 | 112.2, ± 17.3 | 10.2 | 74.0, ± 11.3 | 12.6 | 38.1, ± 9.5 | 4.7 |
>50$ | 467 | 46.5 | 167.7, ± 201.1 | 110.6, ± 14.6 | 4.7 | 73.6, ± 10.2 | 10.1 | 37.1, ± 8.3 | 3.4 |
Arsenical skin lesions | |||||||||
No lesions | 614 | 61.2 | 102.5, ± 154.7 | 113.0, ± 15.7 | 9 | 74.9, ± 10.8 | 13.4 | 72.0, ± 10.8 | 3.4 |
Melanosis | 83 | 8.2 | 177.3, ± 196.4 | 108.1, ± 15.2 | 4.8 | 72.5, ± 9.5 | 7.2 | 35.5, ± 8.1 | 2.4 |
Keratosis | 34 | 3.4 | 250.7, ± 270.0 | 104.1, ± 14.4 | 2.9 | 71.2, ± 10.7 | 2.9 | 32.9, ± 8.3 | 0 |
Leucomelanosis | 273 | 27.2 | 268.1, ± 224.8 | 109.9, ± 17.0 | 6.2 | 72.0, ± 10.8 | 9.2 | 38.0, ± 11.3 | 6.6 |
* As exp. by quartile (µg/L) | |||||||||
1st quartile (10–22) | 296 | 29.5 | 16.5, ±4.7 | 112.2, ±15.0 | 7.8 | 74.9, ±10.9 | 10.8 | 37.2, ±7.4 | 1.7 |
2nd quartile (23–32) | 209 | 20.8 | 28.5, ±3.5 | 112.1, ±17.4 | 10.5 | 74.1, ±10.6 | 13.9 | 38.0, ±9.6 | 4.8 |
3rd quartile (33–261) | 253 | 25.2 | 141, ±67.7 | 110.4, ±16.5 | 5.9 | 73.4, ±10.9 | 11.1 | 37.0, ±8.8 | 4 |
4th quartile (≥262) | 246 | 24.5 | 458.5, ±164.6 | 111.1, ±16.0 | 6.9 | 72.7, ±10.6 | 10.2 | 38.5, ±10.2 | 6.5 |
Arsenic | Overall hypertension | Systolic hypertension § | Diastolic hypertension ψ | Increased pulse pressure φ | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
No. of cases | Adjusted | 95% CI | No. of cases | Adjusted | 95% CI | No. of cases | Adjusted | 95% CI | No. of cases | Adjusted | 95% CI | |
Concentration *, (N) | OR | OR | OR | OR | ||||||||
<50 (532) † | 43 | - | - | 47 | - | - | 64 | - | - | 15 | - | - |
>50 (462) | 23 | 0.93 | 0.49–1.78 | 30 | 1.11 | 0.61–2.02 | 50 | 1.24 | 0.76–2.01 | 26 | 3.54 | 1.46–8.57 |
As_Conc. quartile (µg/L) | N | Overall Hypertension | Pulse Pressure Ɨ | ||||
---|---|---|---|---|---|---|---|
No. of cases | Adj. OR | 95% CI | No of cases | Adj. OR | 95% CI | ||
10–22 * | 291 | 22 | - | - | 5 | - | - |
23–32 | 208 | 19 | 1.33 | 0.67–2.62 | 10 | 3.87 | 1.22–12.20 |
33–261 | 252 | 13 | 1.10 | 0.49–2.44 | 10 | 4.32 | 1.23–15.11 |
≥262 | 243 | 12 | 0.96 | 0.42–2.23 | 16 | 7.32 | 2.18–24.60 |
Duration of Arsenic Exposure (years) | Arsenic Conc. (µg/L) | No. of Overall HTN φ Cases | Overall Hypertension | No. of Pulse Pressure cases | Pulse pressure * | ||
---|---|---|---|---|---|---|---|
Adj. OR | 95% CI | Adj. OR | 95% CI | ||||
<10 | ≤50 † | 12 | - | - | 7 | - | - |
>50 | 10 | 2.05 | 0.61–6.87 | 12 | 2.35 | 0.67–8.30 | |
≥10 | ≤50 † | 31 | - | - | 8 | - | - |
>50 | 13 | 0.72 | 0.32–1.60 | 14 | 5.25 | 1.41–19.51 |
4. Discussion
5. Conclusions
Conflicts of Interest
Acknowledgements
References
- Chen, C.J.; Hsueh, Y.M.; Lai, M.S.; Shyu, M.P.; Chen, S.Y.; Wu, M.M.; Kuo, T.L.; Tai, T.Y. Increased prevalence of hypertension and long-term arsenic exposure. Hypertension 1995, 25, 53–60. [Google Scholar] [CrossRef]
- Tamas, M.J.; Wysocki, R. Mechanisms involved in metalloid transport and tolerance acquisition. Curr. Genet. 2001, 40, 2–12. [Google Scholar] [CrossRef]
- Smith, A.H.; Hopenhayn-Rich, C.; Bates, M.N.; Goeden, H.M.; Hertz-Picciotto, I.; Duggan, H.M.; Wood, R.; Kosnett, M.J.; Smith, M.T. Cancer risks from arsenic in drinking water. Environ. Health Perspect. 1992, 97, 259–267. [Google Scholar]
- Haque, R.; Mazumder, D.N.; Samanta, S.; Ghosh, N.; Kalman, D.; Smith, M.M.; Mitra, S.; Santra, A.; Lahiri, S.; Das, S.; De, B.K.; Smith, A.H. Arsenic in drinking water and skin lesions: Dose-response data from West Bengal, India. Epidemiology 2003, 14, 174–182. [Google Scholar]
- Navas-Acien, A.; Silbergeld, E.K.; Streeter, R.A.; Clark, J.M.; Burke, T.A.; Guallar, E. Arsenic exposure and Type 2 diabetes: A systematic review of the experimental and epidemiologic evidence. Environ. Health Perspect. 2006, 114, 641–648. [Google Scholar]
- Smith, A.H.; Steinmaus, C.M. Health effects of arsenic and chromium in drinking water: Recent human findings. Annu. Rev. Public Health 2009, 30, 107–122. [Google Scholar] [CrossRef]
- Anetor, J.I.; Wanibuchi, H.; Fukushima, S. Arsenic exposure and its health effects and risk of cancer in developing countries: Micronutrients as host defence. Asian Pac. J. Cancer Prev. 2007, 8, 13–23. [Google Scholar]
- Abernathy, C.O.; Thomas, D.J.; Calderon, R.L. Health effects and risk assessment of arsenic. J. Nutr. 2003, 133, 1536S–1538S. [Google Scholar]
- Chiou, H.Y.; Chiou, S.T.; Hsu, Y.H.; Chou, Y.L.; Tseng, C.H.; Wei, M.L.; Chen, C.J. Incidence of transitional cell carcinoma and arsenic in drinking water: A follow-up study of 8,102 residents in an arseniasis-endemic area in northeastern Taiwan. Am. J. Epidemiol. 2001, 153, 411–418. [Google Scholar] [CrossRef]
- Yu, R.C.; Hsu, K.H.; Chen, C.J.; Froines, J.R. Arsenic methylation capacity and skin cancer. Cancer Epidemiol. Biomarkers Prev. 2000, 9, 1259–1262. [Google Scholar]
- Milton, A.H.; Smith, W.; Rahman, B.; Hasan, Z.; Kulsum, U.; Dear, K.; Rakibuddin, M.; Ali, A. Chronic arsenic exposure and adverse pregnancy outcomes in bangladesh. Epidemiology 2005, 16, 82–86. [Google Scholar] [CrossRef]
- Milton, A.H.; Shahidullah, S.M.; Smith, W.; Hossain, K.S.; Hasan, Z.; Ahmed, K.T. Association between chronic arsenic exposure and nutritional status among the women of child bearing age: A case-control study in Bangladesh. Int. J. Environ. Res. Public Health 2010, 7, 2811–2821. [Google Scholar] [CrossRef]
- Islam, M.R.; Khan, I.; Hassan, S.M.N.; McEvoy, M.; D’Este, C.; Attia, J.; Peel, R.; Sultana, M.; Akter, S.; Milton, A.H. Association between type 2 diabetes and chronic arsenic exposure in drinking water: A cross sectional study in Bangladesh. Environ. Health 2012, 11. [Google Scholar] [CrossRef]
- Yang, C.Y. Does arsenic exposure increase the risk of development of peripheral vascular diseases in humans? J. Toxicol. Environ. Health A 2006, 69, 1797–1804. [Google Scholar] [CrossRef]
- Chang, C.C.; Ho, S.C.; Tsai, S.S.; Yang, C.Y. Ischemic heart disease mortality reduction in an arseniasis-endemic area in southwestern Taiwan after a switch in the tap-water supply system. J. Toxicol. Environ. Health A 2004, 67, 1353–1361. [Google Scholar] [CrossRef]
- Merriam-Webster, Definition of Hypertension. In Merriam-Webster’s Medical Dictionary; Merriam Webster Mass Market: Miami, FL, USA, 1995.
- Chen, Y.; Factor-Litvak, P.; Howe, G.R.; Graziano, J.H.; Brandt-Rauf, P.; Parvez, F.; van Geen, A.; Ahsan, H. Arsenic exposure from drinking water, dietary intakes of B Vitamins and folate, and risk of high blood pressure in Bangladesh: A population-based, cross-sectional study. Am. J. Epidemiol. 2007, 165, 541–552. [Google Scholar]
- Kearney, P.M.; Whelton, M.; Reynolds, K.; Muntner, P.; Whelton, P.K.; He, J. Global burden of hypertension: Analysis of worldwide data. Lancet 2005, 365, 217–223. [Google Scholar]
- Novo, S.; Lunetta, M.; Evola, S.; Novo, G. Role of ARBs in the blood hypertension therapy and prevention of cardiovascular events. Curr. Drug Targets 2009, 10, 20–25. [Google Scholar] [CrossRef]
- Sica, D.A. Endocrine causes of secondary hypertension. J. Clin. Hypertens (Greenwich) 2008, 10, 534–540. [Google Scholar]
- Viera, A.J.; Neutze, D.M. Diagnosis of secondary hypertension: An age-based approach. Amer. Family Phys. 2010, 82, 1471–1478. [Google Scholar]
- Carretero, O.A.; Oparil, S. Essential hypertension. Part I: Definition and etiology. Circulation 2000, 101, 329–335. [Google Scholar]
- Kyrou, I.; Chrousos, G.P.; Tsigos, C. Stress, visceral obesity, and metabolic complications. Ann. N Y Acad. Sci. 2006, 1083, 77–110. [Google Scholar] [CrossRef]
- Wofford, M.R.; Hall, J.E. Pathophysiology and treatment of obesity hypertension. Curr. Pharm. Design 2004, 10, 3621–3637. [Google Scholar] [CrossRef]
- Haslam, D.W.; James, W.P. Obesity. Lancet 2005, 366, 1197–1209. [Google Scholar] [CrossRef]
- Lackland, D.T.; Egan, B.M. Dietary salt restriction and blood pressure in clinical trials. Curr. Hypertens Rep. 2007, 9, 314–319. [Google Scholar] [CrossRef]
- Djousséa, L.; Mukamal, K.J. Alcohol consumption and risk of hypertension: Does the type of beverage or drinking pattern matter? Revista Española De Cardiología 2009, 62, 603–605. [Google Scholar]
- Kosugi, T.; Nakagawa, T.; Kamath, D.; Johnson, R.J. Uric acid and hypertension: An age-related relationship? J. Hum. Hypertens 2009, 23. [Google Scholar] [CrossRef]
- Luma, G.B.; Spiotta, R.T. Hypertension in children and adolescents. Am. Fam. Physician 2006, 73, 1558–1568. [Google Scholar]
- Uchiyama, M. Mild hypertension in children. Nippon Rinsho 2008, 66, 1477–1480. [Google Scholar]
- Segura, J.; Ruilope, L.M. Obesity, essential hypertension and renin-angiotensin system. Public Health Nutr. 2007, 10, 1151–1155. [Google Scholar]
- Sorof, J.; Daniels, S. Obesity hypertension in children: A problem of epidemic proportions. Hypertension 2002, 40, 441–447. [Google Scholar] [CrossRef]
- Dastgiri, S.; Mosaferi, M.; Fizi, M.A.; Olfati, N.; Zolali, S.; Pouladi, N.; Azarfam, P. Arsenic exposure, dermatological lesions, hypertension, and chromosomal abnormalities among people in a rural community of northwest Iran. J. Health Popul. Nutr. 2010, 28, 14–22. [Google Scholar]
- Datta, D.V.; Mitra, S.K.; Chhuttani, P.N.; Chakravarti, R.N. Chronic oral arsenic intoxication as a possible aetiological factor in idiopathic portal hypertension (non-cirrhotic portal fibrosis) in India. Gut 1979, 20, 378–384. [Google Scholar] [CrossRef]
- Chiou, H.Y.; Huang, W.I.; Su, C.L.; Chang, S.F.; Hsu, Y.H.; Chen, C.J. Dose-response relationship between prevalence of cerebrovascular disease and ingested inorganic arsenic. Stroke 1997, 28, 1717–1723. [Google Scholar] [CrossRef]
- Rahman, M.; Tondel, M.; Ahmad, S.A.; Chowdhury, I.A.; Faruquee, M.H.; Axelson, O. Hypertension and arsenic exposure in Bangladesh. Hypertension 1999, 33, 74–78. [Google Scholar]
- Chen, C.J.; Wang, S.L.; Chiou, J.M.; Tseng, C.H.; Chiou, H.Y.; Hsueh, Y.M.; Chen, S.Y.; Wu, M.M.; Lai, M.S. Arsenic and diabetes and hypertension in human populations: A review. Toxicol. Appl. Pharmacol. 2007, 222, 298–304. [Google Scholar]
- American Public Health Association, Standard Methods for the Examination of Water and Wastewater, 19th ed; American Public Health Association, American Water Works Association and Water Environment Federation: Washington, DC, USA, 1995.
- The fifth report of the joint national committee on detection, evaluation, and treatment of high blood pressure (JNC V). Arch. Intern. Med. 1993, 153, 149–152.
- Rose, G.A.; Blackburn, H.; Gillum, R.F.; Prineas, R.J. Cardiovascular Survey Methods: World Health Organization; World Health Organization: Geneva, Switzerland, 1982; pp. 82–85. [Google Scholar]
- Shetty, P.S. Body Mass Index, A Measurement of Chronic Energy Deficiency in Adults; Requirements of Ideal Nutritional Anthropometric Index; Food and Agricultural Organization: Rome, Italy, 1994. [Google Scholar]
- Zhang, C.; Mao, G.; He, S.; Yang, Z.; Yang, W.; Zhang, X.; Qiu, W.; Ta, N.; Cao, L.; Yang, H.; et al. Relationship between long-term exposure to low-level arsenic in drinking water and the prevalence of abnormal blood pressure. J. Hazard. Mater. 2012. [Google Scholar] [CrossRef]
- Abir, T.; Rahman, B.; D’Este, C.; Farooq, A.; Milton, A.H. The association between chronic arsenic exposure and hypertension: A meta-analysis. J. Toxicol. 2012. [Google Scholar] [CrossRef]
- Rocchini, A.P. Obesity hypertension. Am. J. Hypertens. 2002, 15, 50S–52S. [Google Scholar] [CrossRef]
- Zureik, M.; Touboul, P.J.; Bonithon-Kopp, C.; Courbon, D.; Berr, C.; Leroux, C.; Ducimetiere, P. Cross-sectional and 4-year longitudinal associations between brachial pulse pressure and common carotid intima-media thickness in a general population: The EVA study. Stroke 1999, 30, 550–555. [Google Scholar]
- Dart, A.M.; Kingwell, B.A. Pulse pressure—A review of mechanisms and clinical relevance. J. Am. Coll. Cardiol. 2001, 37, 975–984. [Google Scholar]
- Domanski, M.; Norman, J.; Wolz, M.; Mitchell, G.; Pfeffer, M. Cardiovascular risk assessment using pulse pressure in the First National Health and Nutrition Examination Survey (NHANES I). Hypertension 2001, 38, 793–797. [Google Scholar] [CrossRef]
- Barchowsky, A.; Roussel, R.R.; Klei, L.R.; James, P.E.; Ganju, N.; Smith, K.R.; Dudek, E.J. Low levels of arsenic trioxide stimulate proliferative signals in primary vascular cells without activating stress effector pathways. Toxicol. Appl. Pharmacol. 1999, 159, 65–75. [Google Scholar] [CrossRef]
- Carmignani, M.; Boscolo, P.; Castellino, N. Metabolic fate and cardiovascular effects of arsenic in rats and rabbits chronically exposed to trivalent and pentavalent arsenic. Arch. Toxicol. Suppl. 1985, 8, 452–455. [Google Scholar] [CrossRef]
- Wang, S.L.; Li, W.F.; Chen, C.J.; Huang, Y.L.; Chen, J.W.; Chang, K.H.; Tsai, L.Y.; Chou, K.M. Hypertension incidence after tap-water implementation: A 13-year follow-up study in the arseniasis-endemic area of southwestern Taiwan. Sci. Total Environ. 2011, 409, 4528–4535. [Google Scholar] [CrossRef]
- Tseng, C.H. Cardiovascular disease in arsenic-exposed subjects living in the arseniasis-hyperendemic areas in Taiwan. Atherosclerosis 2008, 199, 12–18. [Google Scholar] [CrossRef]
- Kwok, R.K.; Mendola, P.; Liu, Z.Y.; Savitz, D.A.; Heiss, G.; Ling, H.L.; Xia, Y.; Lobdell, D.; Zeng, D.; Thorp, J.M. J.; Creason, J.P.; Mumford, J.L. Drinking water arsenic exposure and blood pressure in healthy women of reproductive age in Inner Mongolia, China. Toxicol. Appl. Pharmacol. 2007, 222, 337–343. [Google Scholar] [CrossRef]
- Hsueh, Y.M.; Lin, P.; Chen, H.W.; Shiue, H.S.; Chung, C.J.; Tsai, C.T.; Huang, Y.K.; Chiou, H.Y.; Chen, C.J. Genetic polymorphisms of oxidative and antioxidant enzymes and arsenic-related hypertension. J. Toxicol. Environ. Health A 2005, 68, 1471–1484. [Google Scholar]
- Chen, Y.; Graziano, J.H.; Parvez, F.; Liu, M.; Slavkovich, V.; Kalra, T.; Argos, M.; Islam, T.; Ahmed, A.; Rakibuz-Zaman, M.; Hasan, R.; Sarwar, G.L.; van Geen, A.; Ahsan, H. Arsenic exposure from drinking water and mortality from cardiovascular disease in Bangladesh: Prospective cohort study. BMJ 2011. [Google Scholar] [CrossRef]
- Van Minh, H.; Byass, P.; Chuc, N.T.K.; Wall, S. Gender differences in prevalence and socioeconomic determinants of hypertension: Findings from the WHO STEPs survey in a rural community of Vietnam. J. Hum. Hypertension 2006, 20, 109–115. [Google Scholar] [CrossRef]
- Mohsenin, V.; Yaggi, H.K.; Shah, N.; Dizura, J. The effect of gender on the prevalence of hypertension in obstructive sleep apnea. Sleep Med. 2009, 10, 759–762. [Google Scholar] [CrossRef]
- Lindberg, A.L.; Ekström, E.C.; Nermell, B.; Rahman, M.; Lönnerdal, B.; Persson, L.A.; Vahter, M. Gender and age differences in the metabolism of inorganic arsenic in a highly exposed population in Bangladesh. Environ. Res. 2008, 106, 110–120. [Google Scholar] [CrossRef]
- Vahter, M.; Åkesson, A.; Lidén, C.; Ceccatelli, S.; Berglund, M. Gender differences in the disposition and toxicity of metals. Environ. Res. 2007, 104, 85–95. [Google Scholar] [CrossRef]
© 2012 by the authors; licensee MDPI, Basel, Switzerland. This article is an open-access article distributed under the terms and conditions of the Creative Commons Attribution license (http://creativecommons.org/licenses/by/3.0/).
Share and Cite
Islam, M.R.; Khan, I.; Attia, J.; Hassan, S.M.N.; McEvoy, M.; D'Este, C.; Azim, S.; Akhter, A.; Akter, S.; Shahidullah, S.M.; et al. Association between Hypertension and Chronic Arsenic Exposure in Drinking Water: A Cross-Sectional Study in Bangladesh. Int. J. Environ. Res. Public Health 2012, 9, 4522-4536. https://doi.org/10.3390/ijerph9124522
Islam MR, Khan I, Attia J, Hassan SMN, McEvoy M, D'Este C, Azim S, Akhter A, Akter S, Shahidullah SM, et al. Association between Hypertension and Chronic Arsenic Exposure in Drinking Water: A Cross-Sectional Study in Bangladesh. International Journal of Environmental Research and Public Health. 2012; 9(12):4522-4536. https://doi.org/10.3390/ijerph9124522
Chicago/Turabian StyleIslam, Mohammad Rafiqul, Ismail Khan, John Attia, Sheikh Mohammad Nazmul Hassan, Mark McEvoy, Catherine D'Este, Syed Azim, Ayesha Akhter, Shahnaz Akter, Sheikh Mohammad Shahidullah, and et al. 2012. "Association between Hypertension and Chronic Arsenic Exposure in Drinking Water: A Cross-Sectional Study in Bangladesh" International Journal of Environmental Research and Public Health 9, no. 12: 4522-4536. https://doi.org/10.3390/ijerph9124522