Hypertension Risk in Veterans Exposed to Environmental Toxins

Clinical Implications and Screening Recommendations

The VA/DoD guidelines recommend regular blood pressure screening for veterans with potential burn pit exposure, as hypertension is often asymptomatic and can lead to significant complications including coronary artery disease, heart failure, stroke, and chronic kidney disease 1
The American College of Cardiology recommends using ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring (HBPM) to confirm office readings and exclude white coat hypertension 2
Initial diagnostic workup should include office blood pressure measurement, 12-lead ECG, basic metabolic panel, fasting lipid panel, fasting glucose or HbA1c, urinalysis with albumin-to-creatinine ratio, and thyroid-stimulating hormone (TSH) 2
Target blood pressure should be <130/80 mm Hg for most adults <65 years, and <130 mm Hg for adults ≥65 years 2
First-line pharmacologic treatments include thiazide or thiazide-like diuretics, ACE inhibitors, angiotensin receptor blockers (ARBs), or calcium channel blockers, combined with lifestyle modifications 2

Environmental exposures including lead, cadmium, mercury, and phthalates have been associated with higher blood pressure, though findings have not always been consistent, according to the American Academy of Pediatrics 3, 4