Minireview of relationship between perfluoroalkyl and polyfluoroalkyl substances and hypertension

Table 1 Summary of key epidemiological studies on polyfluoroalkyl substances exposure and hypertension

Ref.	Country	Population	Size	Definition of outcome	Sex	Main results	Negative results
Huang et al[17], 2019	China	Pregnancy	687	Hypertensive disorders of pregnancy	Female	PFBS (AOR = 1.64, 95%CI: 1.09-2.47)	PFHxS, PFUA
				Preeclampsia		PFBS (AOR = 1.81, 95%CI: 1.03-3.17)	PFHxS, PFUA
Borghese et al[18], 2020	Canadian	Pregnancy	1739	Gestational hypertension	Female	PFHxS (OR = 1.15, 95%CI: 0.98-1.35)	PFOA, PFOS
				Preeclampsia		PFHxS (OR = 1.32, 95%CI: 1.03-1.70)	PFOA, PFOS
				SBP		PFOA (β = 0.82, 95%CI: 0.23-1.42)	PFOS
						PFHxS (β = 0.63, 95%CI: 0.29-0.97)
				DBP		PFOA (β = 0.64, 95%CI: 0.24-1.05)	-
						PFOS (β = 0.47, 95%CI: 0.10-0.85)
						PFHxS (β = 0.42, 95%CI: 0.16-0.67)
Preston et al[19], 2022	America	Pregnancy	1558	Gestational hypertension	Female	PFOS (OR = 1.38, 95%CI: 1.04-1.82)	PFNA, EtFOSAA, MeFOSAA, PFDA
						PFOA (OR = 1.51, 95%CI: 1.12-2.03)
						PFHxS (OR = 1.28, 95 CI: 1.06-1.54)
				Preeclampsia		-	PFOS, PFOA, PFHxS, PFNA, EtFOSAA, MeFOSAA, PFDA
				SBP		PFOA (β = 0.62, 95%CI: 0.06-1.18)	PFOS, PFHxS, PFNA, EtFOSAA, MeFOSAA, PFDA
				DBP		PFOS (β = 0.43, 95%CI: 0.05-0.80)	PFHxS, PFNA, EtFOSAA, MeFOSAA, PFDA
						PFOA (β = 0.56, 95%CI: 0.14-0.98)
Zhu et al[20], 2022	America	Pregnancy	8342424	Hypertension	Total	PFOA (OR = 1.009, 95%CI: 1.001-1.016)	-
						PFOS (OR = 1.030, 95%CI: 1.021-1.040)
						PFHpA (OR = 1.008, 95%CI: 1.005-1.011)
						PFHxS (OR = 1.007, 95%CI: 1.004-1.010)
						Total PFAS (OR = 1.032, 95%CI: 1.022-1.042)
Yang et al[21], 2022	China	Pregnancy	826	Gestational hypertension	Female	PFOS (AOR = 0.62, 95%CI: 0.39-0.99)	PFHpA, PFOA, PFHxS, PFNA, PFTrA
						PFDA (AOR = 0.68, 95%CI: 0.47-0.97)
						PFUdA (AOR = 0.67, 95%CI: 0.47-0.94)
						PFDoA (AOR = 0.64, 95%CI: 0.47-0.86)
				SBP		PFOS (aβ = -1.14, 95%CI: -2.10 to -0.18)	PFHpA, PFOA
						PFHxS (aβ = -1.76, 95%CI: -3.16 to -0.35)
						PFDA (aβ = -1.01, 95%CI: -1.71 to -0.30)
						PFuDA (aβ = -0.98, 95%CI: -1.65 to -0.32)
						PFNA (aβ = -0.95, 95%CI: -1.79 to -0.12)
						PFDoA (aβ = -1.05, 95%CI: -1.66 to -0.44)
						PFTrDA (aβ = -0.85, 95%CI: -1.56 to -0.14)
				DBP		PFHxS (aβ = -0.90, 95%CI: -1.75 to -0.04)	PFHpA, PFOA, PFOS, PFDA, PFuDA, PFNA, PFTrA
						PFDoA (aβ = -0.36, 95%CI: -0.72 to 0.00)
Bao et al[22], 2017	China	Adults	1612	Hypertension	Total	Total-PFOS (OR = 1.24, 95%CI: 1.08-1.44)	n-PFOS, 1m-PFOS, Total-PFOA, n-PFOA, PFHxS, PFDA, PFHxA, PFDoA, PFTeA, PFTrA, PFUnA, PFBS, PFDS, PFHpA, PFPA
						Total-Br-PFOS (OR = 1.2, 95%CI: 1.11-1.42)
						6m-PFOS (OR = 1.19, 95%CI: 1.07-1.33)
						3 + 4 + 5m-PFOS (OR = 1.26, 95%CI: 1.12-1.42)
						Σ2m-PFOS (OR = 1.19, 95%CI: 1.03-1.37)
						6m-PFOA (OR = 1.24, 95%CI: 1.05-1.47)
						PFNA (OR = 1.19, 95%CI: 1.04-1.36)
						PFBA (OR = 1.10, 95%CI: 1.04-1.17)
				SBP		Total-PFOS (β = 4.84, 95%CI: 3.55-6.12)	6m-PFOA, PFHxS, PFDA, PFHxA, PFDoA, PFTeA, PFTrA, PFUnA, PFBS, PFDS, PFPA
						n-PFOS (β = 2.99, 95%CI: 1.78-4.20)
						Total-Br-PFOS (β = 4.71, 95%CI: 3.64-5.78)
						1m-PFOS (β = 3.27, 95%CI: 2.20-4.35)
						6m-PFOS (β = 3.67, 95%CI: 2.73-4.62)
						3 + 4 + 5 m-PFOS (β = 4.51, 95%CI: 3.52-5.51)
						Σ2m-PFOS (β = 3.01, 95%CI: 1.67-4.34)
						Total-PFOA (β = 1.69, 95%CI: 0.25-3.13)
						n-PFOA (β = 1.74, 95%CI: 0.33-3.14)
						PFNA (β = 3.01, 95%CI: 1.79-4.23)
						PFBA (β = 0.80, 95%CI: 0.25-1.34)
						PFHpA (β = 1.50, 95%CI: 0.21-2.80)
				DBP		Total-PFOS (β = 2.70, 95%CI: 1.98-3.42)	PFHxS, PFBA, PFHxA, PFTeA, PFTrA, PFUnA, PFBS, PFHpA, PFPA
						n-PFOS (β = 2.02, 95%CI: 1.34-2.70)
						Total-Br-PFOS (β= 2.42, 95%CI: 1.82-3.02)
						1m-PFOS (β = 2.02, 95%CI: 1.42-2.62)
						6m-PFOS (β = 1.70, 95%CI: 1.16-2.23)
						3 + 4 + 5m-PFOS (β = 2.36, 95%CI: 1.80-2.92)
						Σ2m-PFOS (β = 1.12, 95%CI: 0.36-1.87)
						Total-PFOA (β = 2.18, 95%CI: 1.38-2.98)
						n-PFOA (β = 2.12, 95%CI: 1.33-2.90)
						6m-PFOA (β = 1.35, 95%CI: 0.45-2.24)
						PFNA (β = 2.48, 95%CI: 1.80-3.16)
						PFDA (β = 1.19, 95%CI: 0.52-1.87)
						PFDoA (β = 0.59, 95%CI: 0.12-1.07)
						PFDS (β = 0.51, 95%CI: 0.01-1.01)
Pitter et al[23], 2020	Italy	Adults	16224	Hypertension	Total	PFOA (OR = 1.06, 95%CI: 1.01-1.12)	PFNA
						PFOS (OR = 1.12, 95%CI: 1.02-1.22)
						PFHxS (OR = 1.08, 95%CI: 1.02-1.15)
					Male	PFOA (OR = 1.08, 95%CI: 1.02-1.15)	-
						PFOS (OR = 1.17, 95%CI: 1.05-1.31)
						PFHxS (OR = 1.11, 95%CI: 1.03-1.19)
						PFNA (OR = 1.19, 95%CI: 1.02-1.40)
					Female	-	PFOA, PFOS, PFHxS, PFNA
				SBP	Total	PFOA (β = 0.37, 95%CI: 0.19-0.54)	-
						PFOS (β = 0.57, 95%CI: 0.24-0.90)
						PFHxS (β = 0.37, 95%CI: 0.15-0.58)
						PFNA (β = 0.99, 95%CI: 0.47-1.51)
					Male	PFOA (β = 0.46, 95%CI: 0.19-0.73)	-
						PFOS (β = 0.98, 95%CI: 0.47-1.48)
						PFHxS (β = 0.61, 95%CI: 0.30-0.93)
						PFNA (β = 1.46, 95%CI: 0.72-2.19)
					Female	PFOA (β = 0.31, 95%CI: 0.08-0.55)	PFOS, PFHxS, PFNA
				DBP	Total	PFOA (β = 0.34, 95%CI: 0.21-0.47)	-
						PFOS (β = 0.44, 95%CI: 0.20-0.68)
						PFHxS (β = 0.33, 95%CI: 0.17-0.48)
						PFNA (β = 0.62, 95%CI: 0.24-1.00)
					Male	PFOA (β = 0.23, 95%CI: 0.04-0.42)	PFOS, PFNA
						PFHxS (β = 0.29, 95%CI: 0.07-0.51)
					Female	PFOA (β = 0.39, 95%CI: 0.21-0.57)	-
						PFOS (β = 0.51, 95%CI: 0.17-0.84)
						PFHxS (β = 0.26, 95%CI: 0.04-0.49)
						PFNA (β = 0.81, 95%CI: 0.25-1.37)
Averina et al[24], 2021	Norwegian	Adolescents	940	Hypertension	Total	Total PFAS (OR = 1.91, 95%CI: 1.12-3.26)	-
						PFHxS (OR = 2.06, 95%CI: 1.16-3.65)
						PFOA (OR = 2.08, 95%CI: 1.17-3.69)
						PFOS (OR = 1.86, 95%CI: 1.08-3.19)
Ding et al[25], 2022	America	Women	1058	Hypertension	Total	PFOS (HR = 1.18, 95%CI: 1.09-1.28)	PFNA, PFHxS
						n-PFOS (HR = 1.17, 95%CI: 1.08-1.27)
						Sm-PFOS (HR = 1.16, 95%CI: 1.08-1.25)
						n-PFOA (HR = 1.17, 95%CI: 1.07-1.27)
						EtFOSAA (HR = 1.09, 95%CI: 1.04-1.15)
						MeFOSAA (HR = 1.10, 95%CI: 1.03-1.19)
Li et al[26], 2026	America	Adults	5175	Hypertension	Total	PFOA (OR = 1.10, 95%CI: 1.00-1.20)	PFOS, PFUA, PFHxS, PFDA
						PFNA (OR = 1.16, 95%CI: 1.06-1.27)
Xiao et al[27], 2026	America	Adults	6644	Hypertension	Total	PFOA (OR = 1.04, 95%CI: 1.00-1.08)	PFHxS, PFDeA, PFNA, PFUA
						PFOS (OR = 1.04, 95%CI: 1.01-1.07)
						Me-PFOSA-AcOH (OR = 1.07, 95%CI: 1.00-1.14)
Kim et al[28], 2025	Korean	Adults	2993	Hypertension	Total	PFOA (AOR = 1.04, 95%CI: 1.04-1.52)	PFHxS
						PFOS (AOR = 1.36, 95%CI: 1.13-1.65)
						PFNA (AOR = 1.29, 95%CI: 1.07-1.57)
						PFDeA (AOR = 1.37, 95%CI: 1.12-1.67)
						Total PFAS (AOR = 1.05, 95%CI: 1.00-1.10)
Wu et al[29], 2024	China	Adults	10749	Hypertension	Total	PFNA (OR = 1.14, 95%CI: 1.01-1.30)	PFDA, PFHpS. PFOS
					Male	-	PFNA, PFDA, PFHpS, PFOS
					Female	-
Zhao et al[30], 2026	China	Adults	6902	Hypertension	Total	Total PFAS (OR = 1.10, 95%CI: 1.03-1.019)	-
				SBP		Total PFAS (β = 0.036, 95%CI: 0.003-0.069)
				DBP		Total PFAS (β = 0.062, 95%CI: 0.029-0.096)
Mi et al[31], 2020	China	Adults	1238	Hypertension	Total	6:2 Cl-PFESA (AOR = 2.57, 95%CI: 1.86-3.56)	-
						8:2 Cl-PFESA (AOR = 1.18, 95%CI: 1.06-1.32)
						PFOA (AOR = 1.72, 95%CI: 1.27-2.31)
						PFOS (AOR = 2.52, 95%CI: 1.91-3.33)
					Male	-	6:2 Cl-PFESA, 8:2 Cl-PFESA, PFOA, PFOS
					Female	6:2 Cl-PFESA (AOR = 6.81, 95%CI: 3.54- 13.09)	-
						8:2 Cl-PFESA (AOR = 1.135, 95%CI: 1.12-1.63)
						PFOA (AOR = 2.32, 95%CI: 1.38-3.91)
						PFOS (AOR = 8.13, 95%CI: 4.30-15.40)
				SBP	Total	PFOS (β = 2.23, 95%CI: 0.58-3.89)	6:2 Cl-PFESA, 8:2 Cl-PFESA, PFOA
					Male	-	6:2 Cl-PFESA, 8:2 Cl-PFESA, PFOA, PFOS
					Female	6:2 Cl-PFESA (β = 2.99, 95%CI: 1.15-4.83)	8:2 Cl-PFESA, PFOA
						PFOS (β = 3.08, 95%CI: 1.53-4.62)
				DBP	Total	6:2 Cl-PFESA (β = 1.31, 95%CI: 0.13-2.50)	8:2 Cl-PFESA
						PFOA (β = 1.49, 95%CI: 0.34-2.64)
						PFOS (β = 1.66, 95%CI: 0.67-2.65)
					Male	-	6:2 Cl-PFESA, 8:2 Cl-PFESA, PFOA, PFOS
					Female	6:2 Cl-PFESA (β = 1.62, 95%CI: 0.51-2.74)	8:2 Cl-PFESA, PFOA
						PFOS (β = 1.66, 95%CI: 0.67-2.65)
Min et al[33], 2012	America	Adults	2934	Hypertension	Total	PFOA (OR = 2.62, 95%CI: 2.09-3.14)	-
Li et al[34], 2024	America	Adults	4561	Hypertension	Total	PFDeA (OR = 1.2, 95%CI: 1.0-1.4)	PFHxS, PFNA, n-PFOA, Sm-PFOS
						n-PFOS (OR = 1.0, 95%CI: 1.0-1.0)
				SBP		PFDeA (β = 0.7, 95%CI: 0.2-1.1)	-
				DBP		PFDeA (β = 0.8, 95%CI: 0.4-1.2)	-
Liao et al[37], 2026	China	Pregnancy	826	Postpartum new-onset hypertension	Female	PFHxS (OR = 0.83, 95%CI: 0.72-0.97)	-
						PFBS (OR = 1.34, 95%CI: 1.14-1.57)
Donat-Vargas et al[38], 2019	Sweden	Diabetes	187	Hypertension	Total	-	PFOA, PFOS, PFNA, PFHxS, PFDA, PFUnA
Christensen et al[39], 2016	America	Man	154	Hypertension	Male	-	PFHpS, PFHxS, PFNA, PFOA, PFOS, PFuDA
Lin et al[40], 2020	America	Diabetes	957	Hypertension	Total	-	PFOS, PFOA, PFHxS, EtFOSAA, MeFOSAA, PFNA
Winquist and Steenland[41], 2014	America	Adults	32254	Hypertension	Total	-	PFOA
Geiger et al[42], 2014	America	Children	1655	Hypertension	Total	-	PFOA, PFOS
				SBP
				DBP
Birukov et al[43], 2021	Denmark	Pregnancy	1436	Hypertensive disorders of pregnancy	Total	-	PFHxS, PFOS, PFOA, PFNA, PFDA
				Gestational hypertension
				Preeclampsia
				SBP		PFHxS (β = -0.51, 95%CI: -0.97 to -0.04)	PFOS, PFOA, PFNA, PFDA
				DBP		PFOS (β = 0.58, 95%CI: 0.13-1.04)	PFHxS, PFOA, PFNA, PFDA
Säve-Söderbergh et al[44], 2025	Sweden	Pregnancy	109031	Hypertensive disorders of pregnancy	Female	-	Total PFAS
Ebel et al[45], 2023	Sweden	Pregnancy	27292	Hypertension	Female	-	Mixed exposure of PFOS and PFHxS
Thompson et al[46], 2024	America	Pregnancy	513	Gestational hypertension	Female	-	PFOA, PFOS, PFHxS, PFNA
				Preeclampsia
Aker et al[47], 2023	Canadian	Adults	1212	Hypertension	Total	-	PFOA, PFNA, PFDA, PFUnDA, PFHxS, PFOS
Wu et al[48], 2024	America	Total	13921	Hypertension	Total	-	PFHxS, MPAH, PFDE, PFNA, PFUA
Khalil et al[49], 2018	America	Obese children	48	SBP	Total	PFNA (β = 32.4, 95%CI: 9.04-55.7)	PFOA, PFOS, PFHxS
				DBP		-	PFOA, PFOS, PFNA, PFHxS
Ma et al[52], 2019	America	Adolescents	2251	SBP	Total	-	PFOA, PFOS, PFHxS, PFNA
					Boys
					Girls
				DBP	Total	-	PFOA, PFOS, PFHxS, PFNA
					Boys	PFOS (β = 0.025, 95%CI: 0.01-0.05)	PFOA, PFHxS, PFNA
					Girls	-	PFOA, PFOS, PFHxS, PFNA
Wang et al[50], 2025	America	Pregnancy	2018	SBP	Total	PFOS (EE = 0.07, 95%CI: -0.01 to 0.14)	PFNA, PFDA
				DBP		PFHxS (EE = 0.07, 95%CI: 0.02-0.12)
						PFOS (EE = 0.07, 95%CI: 0.01-0.12)
						PFOA (EE = 0.06, 95%CI: 0.00-0.11)
Du et al[51], 2024	China	Children	129	SBP	Total	PFHxS (β = 2.28, 95%CI: 0.15-4.41)	PFDA, PFDoA, PFHpA, PFNA, PFOA, PFOS, PFUA, PFBS
				DBP		PFHxS (β = 3.08, 95%CI: 1.28-4.89)	PFDA, PFDoA, PFHpA, PFNA, PFOA, PFOS, PFUA, PFBS
						-
Chen et al[53], 2019	Croatia	Adults	122	SBP	Total	-	PFOS, PFOA, PFHxS, PFNA
				DBP

PFBS: Perfluorobutane sulfonate; PFHxS: Pperfluorohexane sulfonate; PFUA: Perfluoroundecanoic acid; PFOA: Perfluorooctanoic acid; PFOS: Perfluorooctane sulfonate; PFNA: Perfluorononanoic acid; EtFOSAA: 2-(N-ethyl-perfluorooctane sulfonamido) acetate; MeFOSAA: 2-(N-methyl-perfluorooctane sulfonamido) acetate; PFDA: Perfluorodecanoate; PFHpA: Perfluoroheptanoate; PFuDA: Perfluoroundecanoic acid; PFDoA: Perfluorododecanoic acid; PFTrA: Perfluorotridecanoic acid; PFBA: Perfluorobutanoic acid; PFHxA: Perfluorohexanoic acid; PFTeA: Perfluorotetradecanoic acid; PFUnA: Perfluorododecanoic acid; PFDS: Perfluorodecanesulfonate; PFHpA: Perfluoroheptanoic acid; PFDeA: Perfluoropentanoic acid; PFHpS: Perfluoroheptane sulfonate; Me-PFOSA-AcOH: 2-(N-methylperfluorooctanesulfonamido) acetic acid; MPAH: 2-(N-Methyl-PFOSA) acetic acid; PFDE: Pefluorodecanoic acid; SBP: Systolic blood pressure; DBP: Diastolic blood pressure; CI: Confidence interval; OR: Risk ratio; AOR: Adjusted odds ratio; EE: Effect estimate; HR: Hazard ratio.