Background and Objective: Hypertension remains one of the most important causes of premature

death and comorbidity worldwide. Traditional risk factors associated with hypertension, including dietary

patterns, physical activity, and body mass index, have been described and included in guidelines as important

factors in the development of hypertension. However, epigenetic modifications secondary to exposure to

environmental pollutants have not been recognized as important factors in the development of hypertension.

Epigenetic modifications are reversible changes in the genomic structure that can alter gene expression and

cell function without changes in nucleotide sequence. The most investigated epigenetic modification is DNA

methylation at specific C-p-G points in the genome. Environmental pollutants such as inhaled particulate

matter (PM2.5), cadmium, and lead can result in alterations in DNA methylation.

Methods: This article reviews the biomedical literature (in the PubMed and Embase databases) on the

relation between epigenetic modification due to exposure to environmental pollutants (mainly PM, cadmium,

and lead) and the development of hypertension, as well as literature related to ongoing personalized

medicine therapies to reduce exposure to environmental pollutants, hence decreasing the risk of developing

hypertension.

Key Content and Findings: The review concludes that there is mounting evidence associating the

development of hypertension and exposure to environmental pollutants and also describes how these factors

affect epigenetics. Therapies to avoid exposure to environmental toxins include personal protection such

as respiratory protective equipment, high-efficiency home air filtration, portable air cleaners and personal

protective equipment. However, hypothesis on how epigenetics modifiers specifically affect the pathogenesis

of hypertension needs to be further evaluated in large-scale clinical trials and other prospective studies.

Conclusions: There is mounting evidence linking environmental pollutants such as PM2.5, lead, and

cadmium as contributing factors for the development of hypertension and other cardiovascular disease (CVD),

including coronary artery disease (CAD), peripheral vascular disease (PAD), and strok