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      Long‐Term Effects of Ambient Particulate Matter (With an Aerodynamic Diameter ≤2.5 μm) on Hypertension and Blood Pressure and Attributable Risk Among Reproductive‐Age Adults in China

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          Abstract

          Background

          Epidemiological evidence on the association between long‐term exposure to ambient fine particulate matter (with an aerodynamic diameter ≤2.5 μm; PM 2.5) and hypertension is mixed. We investigated the long‐term association between ambient fine particles and hypertension in reproductive‐age adults.

          Methods and Results

          This analysis included 39 348 119 reproductive‐age (20–49 years) participants from the National Free Preconception Health Examination Project from April 22, 2010 to December 31, 2015 across China. The estimation of annual average ambient PM 2.5 concentrations for each community was realized through using satellite‐based spatial statistical models. Linear mixed models and 2‐level logistic regressions adjusted for potential confounders with natural cubic splines were used to investigate the shape of PM 2.5–blood pressure and PM 2.5‐hypertension, respectively. The effect modification by sex, obesity, smoking status, age, diabetes mellitus, urbanity, race, and region was also taken into account. The concentration‐response relationship between PM 2.5 and hypertension was nonlinear, with a threshold concentration of 47.9 μg/m 3. The odds ratio of hypertension related to a 10‐μg/m 3 increase in PM 2.5 above threshold was 1.010 (95% confidence interval, 1.007–1.012). A 10‐μg/m 3 increase in PM 2.5 above threshold corresponded to a 0.569 (95% confidence interval, 0.564–0.573) mm Hg elevation in systolic blood pressure and a 0.384 (95% confidence interval, 0.381–0.388) mm Hg elevation in diastolic blood pressure. There were 2.3% (95% confidence interval, 2.2%–2.4%) of the hypertension cases that could be attributed to PM 2.5 exposures in reproductive‐age adult populations.

          Conclusions

          Long‐term exposures to PM 2.5 above certain levels might increase population risk for hypertension and might be responsible for China's avoidable hypertension burden in reproductive‐age adults.

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          Air pollution and incidence of hypertension and diabetes mellitus in black women living in Los Angeles.

          Patricia F Coogan, Laura F White, Michael Jerrett … (2012)
          Evidence suggests that longer-term exposure to air pollutants over years confers higher risks of cardiovascular morbidity and mortality than shorter-term exposure. One explanation is that the cumulative adverse effects that develop over longer durations lead to the genesis of chronic disease. Preliminary epidemiological and clinical evidence suggests that air pollution may contribute to the development of hypertension and type 2 diabetes mellitus. We used Cox proportional hazards models to assess incidence rate ratios (IRRs) and 95% confidence intervals (CIs) for incident hypertension and diabetes mellitus associated with exposure to fine particulate matter (PM(2.5)) and nitrogen oxides in a cohort of black women living in Los Angeles. Pollutant levels were estimated at participants' residential addresses with land use regression models (nitrogen oxides) and interpolation from monitoring station measurements (PM(2.5)). Over follow-up from 1995 to 2005, 531 incident cases of hypertension and 183 incident cases of diabetes mellitus occurred. When pollutants were analyzed separately, the IRR for hypertension for a 10-μg/m(3) increase in PM(2.5) was 1.48 (95% CI, 0.95-2.31), and the IRR for the interquartile range (12.4 parts per billion) of nitrogen oxides was 1.14 (95% CI, 1.03-1.25). The corresponding IRRs for diabetes mellitus were 1.63 (95% CI, 0.78-3.44) and 1.25 (95% CI, 1.07-1.46). When both pollutants were included in the same model, the IRRs for PM(2.5) were attenuated and the IRRs for nitrogen oxides were essentially unchanged for both outcomes. Our results suggest that exposure to air pollutants, especially traffic-related pollutants, may increase the risk of type 2 diabetes mellitus and possibly of hypertension.
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            Associations of Short-Term and Long-Term Exposure to Ambient Air Pollutants With Hypertension: A Systematic Review and Meta-Analysis.

            Yuanyuan Cai, Bo Zhang, Weixia Ke … (2016)
            Hypertension is a major disease of burden worldwide. Previous studies have indicated that air pollution might be a risk factor for hypertension, but the results were controversial. To fill this gap, we performed a meta-analysis of epidemiological studies to investigate the associations of short-term and long-term exposure to ambient air pollutants with hypertension. We searched all of the studies published before September 1, 2015, on the associations of ozone (O3), carbon monoxide (CO), nitrogen oxide (NO2 and NOX), sulfur dioxide (SO2), and particulate matter (PM10 and PM2.5) with hypertension in the English electronic databases. A pooled odds ratio (OR) for hypertension in association with each 10 μg/m(3) increase in air pollutant was calculated by a random-effects model (for studies with significant heterogeneity) or a fixed-effect model (for studies without significant heterogeneity). A total of 17 studies examining the effects of short-term (n=6) and long-term exposure (n=11) to air pollutants were identified. Short-term exposure to SO2 (OR=1.046, 95% confidence interval [CI]: 1.012-1.081), PM2.5 (OR=1.069, 95% CI: 1.003-1.141), and PM10 (OR=1.024, 95% CI: 1.016-1.032) were significantly associated with hypertension. Long-term exposure (a 10 μg/m(3) increase) to NO2 (OR=1.034, 95% CI: 1.005-1.063) and PM10 (OR=1.054, 95% CI: 1.036-1.072) had significant associations with hypertension. Exposure to other ambient air pollutants (short-term exposure to NO2, O3, and CO and long-term exposure to NOx, PM2.5, and SO2) also had positive relationships with hypertension, but lacked statistical significance. Our results suggest that short-term or long-term exposure to some air pollutants may increase the risk of hypertension.
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              Long-term air pollution exposure and risk factors for cardiovascular diseases among the elderly in Taiwan.

              Jen-Hsiang Chuang, Yuan Yan, Shu-Jun Chiu … (2010)
              To investigate changes in blood pressure, blood lipids, blood sugar and haematological markers of inflammation associated with changes in long-term exposure to ambient air pollutants. We conducted secondary analyses of data on blood pressure and blood biochemistry markers from the Social Environment and Biomarkers of Aging Study in Taiwan and air pollution data from the Taiwan Environmental Protection Administration in 2000. Associations of 1-year averaged criteria air pollutants (particulate matter with aerodynamic diameters <10 μm (PM(10)) and <2.5 μm (PM(2.5)), ozone (O(3)), nitrogen dioxide (NO(2)), sulfur dioxide and carbon monoxide) with systolic blood pressure, diastolic blood pressure, total cholesterol, triglycerides, high-density lipoprotein cholesterol, fasting glucose, haemoglobin A1c (HbA1c), interleukin 6 (IL-6) and neutrophils were explored by applying generalised additive models. After controlling for potential confounders, we observed that increased 1-year averaged particulate air pollutants (PM(10) and PM(2.5)) and NO(2) were associated with elevated blood pressure, total cholesterol, fasting glucose, HbA1c, IL-6 and neutrophils. Associations of increased 1-year averaged O(3) with elevated blood pressure, total cholesterol, fasting glucose, HbA1c and neutrophils were also observed. In particular, our two-pollutant models showed that PM(2.5) was more significantly associated with end-point variables than two gaseous pollutants, O(3) and NO(2). Changes in blood pressure, blood lipids, blood sugar and haematological markers of inflammation are associated with long-term exposure to ambient air pollutants. This might provide a link between air pollution and atherosclerotic cardiovascular diseases.
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                Author and article information

                Contributors
                Yuan He: heyuan8506@126.com
                Journal
                Journal ID (nlm-ta): J Am Heart Assoc
                Journal ID (iso-abbrev): J Am Heart Assoc
                Journal ID (doi): 10.1002/(ISSN)2047-9980
                Journal ID (publisher-id): JAH3
                Journal ID (hwp): ahaoa
                Title: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Electronic): 2047-9980
                Publication date (Electronic): 26 April 2018
                Publication date Collection: 01 May 2018
                Volume: 7
                Issue: 9 ( doiID: 10.1002/jah3.2018.7.issue-9 )
                Electronic Location Identifier: e008553
                Affiliations
                [ 1 ] National Research Institute for Health and Family Planning Beijing China
                [ 2 ] Graduate School of Peking Union Medical College Beijing China
                [ 3 ] Department of Maternal and Child Health National Health and Family Planning Commission Beijing China
                [ 4 ] Department of Computer Science and Engineering Washington University, St Louis MO
                [ 5 ] Research Center for Population Health and Risk Assessment National Human Genetic Resources Center Beijing China
                Author notes
                [*] [* ] Correspondence to: Yuan He, MD, National Research Institute for Health and Family Planning, Beijing 100181, China. E‐mail: heyuan8506@ 123456126.com
                Article
                Publisher ID: JAH33063
                DOI: 10.1161/JAHA.118.008553
                PMC ID: 6015291
                PubMed ID: 29700042
                SO-VID: 729414b2-68c2-43ed-a52a-edc94378b1b9
                Copyright © © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
                License:

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                Date received : 04 January 2018
                Date accepted : 20 February 2018
                Page count
                Figures: 3, Tables: 5, Pages: 11, Words: 7076
                Funding
                Funded by: National Key Research and Development Program of China
                Award ID: 2016YFC1000307
                Award ID: 2016YFC1000102‐2
                Funded by: National Natural Science Foundation of China
                Award ID: 81602854
                Funded by: National Scientific Data Sharing Platform for Population and Health
                Award ID: 2016NCMIZX06
                Categories
                Subject: Original Research
                Subject: Original Research
                Subject: Hypertension
                Custom metadata
                source-schema-version-number 2.0
                component-id jah33063
                cover-date 01 May 2018
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_NLMPMC version:version=5.3.7.2 mode:remove_FC converted:01.05.2018

                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: air pollution,blood pressure,china,hypertension,high blood pressure
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: air pollution, blood pressure, china, hypertension, high blood pressure

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