Association of exposure to di-2-ethylhexylphthalate replacements with increased blood pressure in children and adolescents

Hypertension. 2015 Aug;66(2):301-8. doi: 10.1161/HYPERTENSIONAHA.115.05603.


Phthalates are environmental chemicals widely used in consumer and personal care products. In this study, we examined associations of urinary phthalates with blood pressure, triglycerides, and lipoproteins in children and adolescents, performing a cross-sectional analysis of a subsample of US children 6 to 19 years of age who participated in the National Health and Nutrition Examination Survey between the years 2009 and 2012. We quantified exposure to common environmental phthalates, with a focus on the dietary contaminant di-2-ethylhexylphthalate and 2 increasingly used replacements, di-isononyl phthalate and di-isodecyl phthalate, based on micromolar concentration of urinary metabolites. We assessed descriptive, univariate, and multivariable associations with blood pressure and lipids. Controlling for an array of sociodemographic and behavioral factors, as well as diet and body mass, metabolites of di-2-ethylhexylphthalate, di-isononyl phthalate, and di-isodecyl phthalate were associated with higher age-, sex- and height-standardized blood pressure. For each log unit increase in di-isodecyl phthalate metabolites, a 0.105 standard deviation unit increase in systolic blood pressure z score was identified (P=0.004); for di-isononyl phthalate metabolites, a 0.113 standard deviation unit increment was identified (P=0.008). For di-2-ethylhexylphthalate metabolites, a 0.103 standard deviation unit increment (P=0.013) was detected. Metabolites of low molecular weight phthalates commonly found in cosmetics and personal care products showed an association with blood pressure (≥90th percentile) in univariate analysis, but this was no longer significant in our full multivariable model, suggesting specificity. Phthalate metabolites were not associated with triglycerides or high-density lipoproteins. Further, longitudinal studies are needed to confirm these associations and to assess opportunities for intervention.

Keywords: blood pressure; children; cross-sectional studies; endocrine disrupting chemicals; high-density lipoproteins; hypertyension; triglycerides.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Blood Pressure / physiology
  • Child
  • Cross-Sectional Studies
  • Diethylhexyl Phthalate / adverse effects*
  • Diethylhexyl Phthalate / urine
  • Endocrine Disruptors / adverse effects*
  • Endocrine Disruptors / urine
  • Female
  • Humans
  • Hypertension / epidemiology*
  • Hypertension / physiopathology
  • Incidence
  • Male
  • Multivariate Analysis
  • Nutrition Surveys
  • Phthalic Acids / adverse effects*
  • Phthalic Acids / urine
  • Regression Analysis
  • Retrospective Studies
  • United States


  • Endocrine Disruptors
  • Phthalic Acids
  • diisononyl phthalate
  • Diethylhexyl Phthalate
  • diisodecyl phthalate