Exposure to ambient particulate matter air pollution, blood pressure and hypertension in children and adolescents: A national cross-sectional study in China

Long-term exposure to fine particulate matter components with obesity in children and adolescents in China: The age-sex disparities and key effect modifiers

Long-term fine particulate matter (PM2.5) exposure was associated with childhood obesity. However, the key PM2.5 components and whether PM2.5 effect may vary by obesity type, growth stage, sex, and individual/family characteristics have yet been examined. In this study, we investigated 213,907 Chinese children and adolescents aged 3-18 years in 2017-2019. Three-year average concentrations of PM2.5 and five major components were assigned to each participant's address. Multivariable mixed-effects model and weighted quantile sum regression were used to estimate the effect sizes of each component. Stratified analyses were performed by age and sex groups, with the interactive effects of a series of individual/family features evaluated. The odds ratio of childhood obesity was 1.28 (95 %CI: 1.15-1.43) for per interquartile range increase in PM2.5, with organic matter identified as the key contributor. General central obesity and mixed obesity were more sensitive to PM2.5 exposure than peripheral obesity. As children aged, the effect size of PM2.5 attenuated for general central obesity, remained unchanged for mixed obesity and increased for peripheral obesity. Females, children with obese parents, and those with lower levels of physical activity were more vulnerable than others. Other adverse effect modifiers for certain children included family with one child, low family income, and less sleep duration. Our findings emphasize that the influence of exposure to PM2.5 and its components on risk of obesity in children and adolescents should be considered comprehensively in developing adequate obesity prevention strategies.

Childhood exposure to air pollution, noise, and surrounding greenness and incident hypertension in early adulthood in a US nationwide cohort-the Growing Up Today Study (GUTS)

Exposure to increased air pollution, noise, and reduced surrounding greenness have been suggested as potential environmental risk factors for hypertension in adults, but limited evidence exists regarding early-life exposure, particularly from prospective studies. We investigated independent and joint associations of childhood exposure to these factors with incident hypertension in early adulthood in a US nationwide cohort. Study participants were from the Growing Up Today Study (GUTS) established in 1996 (GUTSI) and 2004 (GUTSII), who were ages 9-14 (GUTSI) or 10-17 (GUTSII) at enrollment. Incident hypertension was identified by self-report on questionnaires from 2010 to 2021. We estimated residential exposures to air pollution (from spatiotemporal models), noise, and surrounding greenness throughout childhood (10-18y). We applied Cox proportional hazards models adjusted for potential confounders to assess hazard ratios (HRs) and 95% confidence intervals (CIs) associated with each interquartile range (IQR) change in exposure. We performed a quantile g-computation to assess the joint association of simultaneous exposure to the mixture. We considered potential effect modification by sex, maternal history of hypertension, overweight/obese status at age 18, urbanicity, and neighborhood socioeconomic status. Among 17,762 participants, 1530 hypertensive cases occurred during an average follow-up of 12.8 years. HRs for all exposures were small with CIs including unity. A joint HR of 1.03 (95% CI: 0.95, 1.11) was associated with a one-quartile increase across simultaneous exposure to the environmental mixture. The joint associations were stronger among non-obese participants or participants living in less advantaged neighborhoods: HRs of 1.07 (95% CI: 0.97, 1.18) and 1.08 (95% CI: 0.98, 1.18), respectively. In conclusion, we did not identify an independent or joint association between childhood exposure to air pollution, noise, and surrounding greenness and early adulthood hypertension. However, a positive joint association was suggested among non-obese participants or those living in less advantaged neighborhoods.

Anti-inflammatory diet mitigate cardiovascular risks due to particulate matter exposure in women during pregnancy: A perspective cohort study from China

BACKGROUND

Particulate matter (PM) exposure during pregnancy may increase cardiovascular risk (CVR). However, the specific time windows of exposure contributing to this association and the potential biological mechanisms underlying it remain unclear.

OBJECTIVE

To determine the sensitive time window for CVR related to PM exposure. We investigated whether levels of inflammatory biomarkers mediate the relationship between PM exposure and CVR, and examined the potential impact of an anti-inflammatory diet on this association.

METHODS

From 2015 to 2021, 9294 pregnant women from three Hefei hospitals were included. We used a 1 × 1 km satellite dataset to assess PM1, PM2.5, and PM10 exposure. High-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) were measured as inflammatory biomarkers. The empirical dietary inflammatory pattern (EDIP) score, based on a validated food frequency questionnaire. The CVR score was calculated using five clinical metrics based on American Heart Association criteria.

RESULTS

We found a significant association between PM exposure and increased CVR score, especially during the 2nd to 8th weeks of the first trimester. For every increase of 10-μg/m3 of PM1, PM2.5, and PM10, there was an associated increase in CVR of 0.51 (95%CI: 0.21, 082), 0.25 (95% CI: 0.11 to 0.39), and 0.29 (95% CI: 0.09 to 0.37), respectively. Mediation analysis revealed that the proportion of the association between PM1, PM2.5, and PM10 exposure and CVR mediated by inflammatory biomarkers was 24.3%, 22.4%, and 20.1%, respectively. Stratified analyses showed no positive correlation between PM exposure and CVR in the anti-inflammatory diet (low EDIP) group. The β coefficients were 0.52 for PM1 (95% CI: -0.06 to 1.11), 0.31 for PM2.5 (95% CI: -0.04 to 0.79), and 0.25 for PM10 (95% CI: -0.03 to 0.54).

CONCLUSIONS

PM exposure, particularly during weeks 2-8 of pregnancy, correlates with CVR, partly mediated by levels of inflammatory biomarkers. An anti-inflammatory diet mitigates CVR associated with PM exposure.

Air pollution generated in an industrial region: Effect on the cardiovascular health of humans and damage caused to a plant species, Piper gaudichaudianum (Piperaceae), used for biomonitoring

Atmospheric pollution due to anthropogenic activities is a complex mixture of gasses and particulate matter (PM) that is currently one of the main causes of premature death in the world. Similarly, it is also capable of directly interfering with plant species by reducing their photosynthetic capacity and growth and killing cells. This work is about an observational study conducted in a region with two industries: a mine and an automobile parts manufacturer. Mining rocks is a source of PM in the air like that caused by other industrial activities. Twenty-five people that work or live in the industrial region cited (area A) and 25 people that live further away (area B) were selected to evaluate their vital signs and conduct a transthoracic echocardiogram. Leaves of Piper gaudichaudianum (Piperaceae), a native plant species, were also collected in both areas and evaluated in a laboratory. The PM accumulated on the leaves was evaluated using scanning electron microscopy (SEM) and inductively coupled plasma-optical emission spectrometry (ICP-OES). A statistical difference (P < 0.05) was verified for the levels of systolic blood pressure (SBP), diastolic blood pressure (DBP), and left ventricular mass index by echocardiography; the values were greater in people in area A. For the plant analysis, there was a statistical difference for all characters evaluated, chlorophyll levels, fresh mass, dry mass and leaf area were reduced, and thickness was greater in area A (P < 0.001). The PM analysis revealed a predominance of silicon, iron, and aluminum chemical elements. The present study suggests that particulate matter pollution is harmful to both humans and the flora.

Effects of Scutellaria baicalensis Extract-Induced Exosomes on the Periodontal Stem Cells and Immune Cells under Fine Dust

In adverse environments, fine dust is linked to a variety of health disorders, including cancers, cardiovascular, neurological, renal, reproductive, motor, systemic, and respiratory diseases. Although PM10 is associated with oral inflammation and cancer, there is limited research on biomaterials that prevent damage caused by fine dust. In this study, we evaluated the effects of biomaterials using microRNA profiling, flow cytometry, conventional PCR, immunocytochemistry, Alizarin O staining, and ELISA. Compared to SBE (Scutellaria baicalensis extract), the preventive effectiveness of SBEIEs (SBE-induced exosomes) against fine dust was approximately two times higher. Furthermore, SBEIEs promoted cellular differentiation of periodontal ligament stem cells (PDLSCs) into osteoblasts, periodontal ligament cells (PDLCs), and pulp progenitor cells (PPCs), enhancing immune modulation for oral health against fine dust. In terms of immune modulation, SBEIEs activated the secretion of cytokines such as IL-10, LL-37, and TGF-β in T cells, B cells, and macrophages, while attenuating the secretion of MCP-1 in macrophages. MicroRNA profiling revealed that significantly modulated miRNAs in SBEIEs influenced four biochemical categories: apoptosis, cellular differentiation, immune activation, and anti-inflammation. These findings suggest that SBEIEs are an optimal biomaterial for developing oral health care products. Additionally, this study proposes functional microRNA candidates for the development of pharmaceutical liposomes.

Prevalence of childhood hypertension and associated factors in Zhejiang Province: a cross-sectional analysis based on random forest model and logistic regression

With childhood hypertension emerging as a global public health concern, understanding its associated factors is crucial. This study investigated the prevalence and associated factors of hypertension among Chinese children. This cross-sectional investigation was conducted in Pinghu, Zhejiang province, involving 2,373 children aged 8-14 years from 12 schools. Anthropometric measurements were taken by trained staff. Blood pressure (BP) was measured in three separate occasions, with an interval of at least two weeks. Childhood hypertension was defined as systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) ≥ age-, sex-, and height-specific 95th percentile, across all three visits. A self-administered questionnaire was utilized to collect demographic, socioeconomic, health behavioral, and parental information at the first visit of BP measurement. Random forest (RF) and multivariable logistic regression model were used collectively to identify associated factors. Additionally, population attributable fractions (PAFs) were calculated. The prevalence of childhood hypertension was 5.0% (95% confidence interval [CI]: 4.1-5.9%). Children with body mass index (BMI) ≥ 85th percentile were grouped into abnormal weight, and those with waist circumference (WC) > 90th percentile were sorted into central obesity. Normal weight with central obesity (NWCO, adjusted odds ratio [aOR] = 5.04, 95% CI: 1.96-12.98), abnormal weight with no central obesity (AWNCO, aOR = 4.60, 95% CI: 2.57-8.21), and abnormal weight with central obesity (AWCO, aOR = 9.94, 95% CI: 6.06-16.32) were associated with an increased risk of childhood hypertension. Childhood hypertension was attributable to AWCO mostly (PAF: 0.64, 95% CI: 0.50-0.75), followed by AWNCO (PAF: 0.34, 95% CI: 0.19-0.51), and NWCO (PAF: 0.13, 95% CI: 0.03-0.30). Our results indicated that obesity phenotype is associated with childhood hypertension, and the role of weight management could serve as potential target for intervention.

Osteogenic Protection against Fine Dust with Erucic Acid-Induced Exosomes

Fine dust causes various disorders, including cardiovascular, neurological, renal, reproductive, motor, systemic, respiratory, and cancerous diseases. Therefore, it is essential to study functional materials to prevent these issues. This study investigated the beneficial effects of erucic acid against fine dust using methods such as miRNA profiling, quantitative PCR, flow cytometry, ELISA, and Alizarin O staining. Erucic acid effectively suppresses inflammation and upregulates osteogenic activators in fibroblasts exposed to fine dust. Additionally, erucic acid-induced exosomes (EIEs) strongly counteract the negative effects of fine dust on osteocytic differentiation and inflammation. Despite fine dust exposure, EIEs promoted osteocytic differentiation in adipose-derived stem cells (ASCs) and enhanced osteogenesis and phagocytosis in macrophages. The significant upregulation of RunX2 and BMP7 by EIEs indicates its strong role in osteocytic differentiation and protection against the effects of fine dust. EIEs also boosts immune activity and acts as an osteogenic trigger for macrophages. MicroRNA profiling revealed that EIEs dramatically upregulated miRNAs, including hsa-miRNA-1301-3p, hsa-miRNA-1908-5p, hsa-miRNA-423-5p, and hsa-miRNA-122-5p, which are associated with osteogenic differentiation and immunity. Therefore, EIEs show potential as biomaterials to prevent environment-borne diseases.

Phthalate exposure and blood pressure in U.S. children aged 8-17 years (NHANES 2013-2018)

BACKGROUND

Current evidence from epidemiologic studies suggested that phthalate metabolites might be associated with blood pressure (BP) changes. However, the special relationship between phthalate metabolites and BP changes in children has not been clearly elucidated in existing researches.

OBJECTIVES

We investigated the links between phthalate metabolites and various BP parameters, including systolic/diastolic BP, mean arterial pressure (MAP), and the presence of hypertension.

METHODS

The population sample consisted of 1036 children aged 8 to 17 years from the 2013-2018 NHANES in the United States. High performance liquid chromatography-electrospray ionization-tandem mass spectrometry was used to measure urinary concentrations of 19 phthalate metabolites. Systolic/diastolic BP were derived from the average of three valid measurements, and MAP was calculated as (systolic BP + 2 × diastolic BP)/3. Hypertension was defined as mean systolic BP and/or diastolic BP that was ≥ 95th percentile for gender, age, and height reference. Linear regression, logistic regression, and weighted quantile sum (WQS) regression models were employed to assess the associations between phthalate exposure and systolic/diastolic BP, MAP, and hypertension.

RESULTS

Ten of 19 phthalate metabolites including MCNP, MCOP, MECPP, MBP, MCPP, MEP, MEHHP, MiBP, MEOHP, and MBzP had detection frequencies > 85% with samples more than 1000. MCNP, MCOP, MECPP, MBP, MCPP, MEHHP, MiBP, MEOHP, and MBzP were generally negatively associated with systolic/diastolic BP and MAP, but not protective factors for hypertension. These associations were not modified by age (8-12 and 13-17 years) or sex (boys and girls). The above-mentioned associations were further confirmed by the application of the WQS analysis, and MCOP was identified as the chemical with the highest weight.

CONCLUSION

Phthalate metabolites were associated with modest reductions in systolic/diastolic BP, and MAP in children, while appeared not protective factors for hypertension. Given the inconsistent results among existing studies, our findings should be confirmed by other cohort studies.

Long-term exposure to particulate matter is associated with elevated blood pressure: Evidence from the Chinese plateau area

Background

Ambient air pollution could increase the risk of hypertension; however, evidence regarding the relationship between long-term exposure to particulate matter and elevated blood pressure in plateau areas with lower pollution levels is limited.

Methods

We assessed the associations of long-term exposure to particulate matter (PM, PM1, PM2.5, and PM10) with hypertension, diastolic blood pressure (DBP), systolic blood pressure (SBP) and pulse pressure (PP) in 4.235 Tibet adults, based on the baseline of the China multi-ethnic cohort study (CMEC) in Lhasa city, Tibet from 2018-19. We used logistic regression and linear regression models to evaluate the associations of ambient PM with hypertension and blood pressure, respectively.

Results

Long-term exposure to PM1, PM2.5, and PM10 is positively associated with hypertension, DBP, and SBP, while negatively associated with PP. Among these air pollutants, PM10 had the strongest effect on hypertension, DBP, and SBP, while PM2.5 had the strongest effect on PP. The results showed for hypertension odds ratio (OR) = 1.99; 95% confidence interval (CI) = 1.58, 2.51 per interquartile range (IQR) μg/m3 increase in PM1, OR = 1.93; 95% CI = 1.55, 2.40 per IQR μg/m3 increase in PM2.5, and OR = 2.12; 95% CI = 1.67, 2.68 per IQR μg/m3 increase in PM10.

Conclusions

Long-term exposure to ambient air pollution was associated with an increased risk of hypertension, elevated SBP and DBP levels, and decreased PP levels. To reduce the risk of hypertension and PP reduction, attention should be paid to air quality interventions in plateau areas with low pollution levels.

Adverse effects of exposure to fine particles and ultrafine particles in the environment on different organs of organisms

Particulate pollution is a global risk factor that seriously threatens human health. Fine particles (FPs) and ultrafine particles (UFPs) have small particle diameters and large specific surface areas, which can easily adsorb metals, microorganisms and other pollutants. FPs and UFPs can enter the human body in multiple ways and can be easily and quickly absorbed by the cells, tissues and organs. In the body, the particles can induce oxidative stress, inflammatory response and apoptosis, furthermore causing great adverse effects. Epidemiological studies mainly take the population as the research object to study the distribution of diseases and health conditions in a specific population and to focus on the identification of influencing factors. However, the mechanism by which a substance harms the health of organisms is mainly demonstrated through toxicological studies. Combining epidemiological studies with toxicological studies will provide a more systematic and comprehensive understanding of the impact of PM on the health of organisms. In this review, the sources, compositions, and morphologies of FPs and UFPs are briefly introduced in the first part. The effects and action mechanisms of exposure to FPs and UFPs on the heart, lungs, brain, liver, spleen, kidneys, pancreas, gastrointestinal tract, joints and reproductive system are systematically summarized. In addition, challenges are further pointed out at the end of the paper. This work provides useful theoretical guidance and a strong experimental foundation for investigating and preventing the adverse effects of FPs and UFPs on human health.

Association between ambient particulate matter levels and hypertension: results from the Korean Genome and Epidemiology Study

Background

Recently, there has been increasing worldwide concern about outdoor air pollution, especially particulate matter (PM), which has been extensively researched for its harmful effects on the respiratory system. However, sufficient research on its effects on cardiovascular diseases, such as hypertension, remains lacking. In this study, we examine the associations between PM levels and hypertension and hypothesize that higher PM concentrations are associated with elevated blood pressure.

Methods

A total of 133,935 adults aged ≥ 40 years who participated in the Korean Genome and Epidemiology Study were analyzed. Multiple linear regression analyses were conducted to investigate the short- (1-14 days), medium- (1 and 3 months), and long-term (1 and 2 years) impacts of PM on blood pressure. Logistic regression analyses were conducted to evaluate the medium- and long-term effects of PM on blood pressure elevation after adjusting for sex, age, body mass index, health-related lifestyle behaviors, and geographic areas.

Results

Using multiple linear regression analyses, both crude and adjusted models generated positive estimates, indicating an association with increased blood pressure, with all results being statistically significant, with the exception of PM levels over the long-term period (1 and 2 years) in non-hypertensive participants. In the logistic regression analyses on non-hypertensive participants, moderate PM10 (particulate matter with diameters < 10 μm) and PM2.5 (particulate matter with diameters < 2.5 μm) levels over the long-term period and all high PM10 and PM2.5 levels were statistically significant after adjusting for various covariates. Notably, high PM2.5 levels of the 1 year exhibited the highest odds ratio of 1.23 (95% confidence interval: 1.19-1.28) after adjustment.

Conclusions

These findings suggest that both short- and long-term exposure to PM is associated with blood pressure elevation.

Short-Term Exposure to Ambient Air Pollution and Influenza: A Multicity Study in China

BACKGROUND

Air pollution is a major risk factor for planetary health and has long been suspected of predisposing humans to respiratory diseases induced by pathogens like influenza viruses. However, epidemiological evidence remains elusive due to lack of longitudinal data from large cohorts.

OBJECTIVE

Our aim is to quantify the short-term association of influenza incidence with exposure to ambient air pollutants in Chinese cities.

METHODS

Based on air pollutant data and influenza surveillance data from 82 cities in China over a period of 5 years, we applied a two-stage time series analysis to assess the association of daily incidence of reported influenza cases with six common air pollutants [particulate matter with aerodynamic diameter ≤ 2.5 μ m (PM 2.5 ), particulate matter with aerodynamic diameter ≤ 10 μ m (PM 10 ), NO 2 , SO 2 , CO, and O 3 ], while adjusting for potential confounders including temperature, relative humidity, seasonality, and holiday effects. We built a distributed lag Poisson model for one or multiple pollutants in each individual city in the first stage and conducted a meta-analysis to pool city-specific estimates in the second stage.

RESULTS

A total of 3,735,934 influenza cases were reported in 82 cities from 2015 to 2019, accounting for 72.71% of the overall case number reported in the mainland of China. The time series models for each pollutant alone showed that the daily incidence of reported influenza cases was positively associated with almost all air pollutants except for ozone. The most prominent short-term associations were found for SO 2 and NO 2 with cumulative risk ratios of 1.094 [95% confidence interval (CI): 1.054, 1.136] and 1.093 (95% CI: 1.067, 1.119), respectively, for each 10   μ g / m 3 increase in the concentration at each of the lags of 1-7 d. Only NO 2 showed a significant association with the daily incidence of influenza cases in the multipollutant model that adjusts all six air pollutants together. The impact of air pollutants on influenza was generally found to be greater in children, in subtropical cities, and during cold months.

DISCUSSION

Increased exposure to ambient air pollutants, particularly NO 2 , is associated with a higher risk of influenza-associated illness. Policies on reducing air pollution levels may help alleviate the disease burden due to influenza infection. https://doi.org/10.1289/EHP12146.

Mediating effect of body fat percentage in the association between ambient particulate matter exposure and hypertension: a subset analysis of China hypertension survey

BACKGROUND

Hypertension caused by air pollution exposure is a growing concern in China. The association between air pollutant exposure and hypertension has been found to be potentiated by obesity, however, little is known about the processes mediating this association. This study investigated the association between fine particulate matter (aerodynamic equivalent diameter ≤ 2.5 microns, PM2.5) exposure and the prevalence of hypertension in a representative population in southern China and tested whether obesity mediated this association.

METHODS

A total of 14,308 adults from 48 communities/villages in southern China were selected from January 2015 to December 2015 using a stratified multistage random sampling method. Hourly PM2.5 measurements were collected from the China National Environmental Monitoring Centre. Restricted cubic splines were used to analyze the nonlinear dose-response relationship between PM2.5 exposure and hypertension risk. The mediating effect mechanism of obesity on PM2.5-associated hypertension was tested in a causal inference framework following the approach proposed by Imai and Keele.

RESULTS

A total of 20.7% (2966/14,308) of participants in the present study were diagnosed with hypertension. Nonlinear exposure-response analysis revealed that exposure to an annual mean PM2.5 concentration above 41.8 µg/m3 was associated with increased hypertension risk at an incremental gradient. 9.1% of the hypertension burden could be attributed to exposure to elevated annual average concentrations of PM2.5. It is noteworthy that an increased body fat percentage positively mediated 59.3% of the association between PM2.5 exposure and hypertension risk, whereas body mass index mediated 34.3% of this association.

CONCLUSIONS

This study suggests that a significant portion of the estimated effect of exposure to PM2.5 on the risk of hypertension appears to be attributed to its effect on alterations in body composition and the development of obesity. These findings could inform intersectoral actions in future studies to protect populations with excessive fine particle exposure from developing hypertension.

An updated systematic review and meta-analysis on portable air cleaners and blood pressure: Recommendations for users and manufacturers

Fine particulate matter (PM2.5) air pollution is a leading contributor to the global burden of cardiovascular disease (CVD). One important underlying mechanism is an increase in blood pressure (BP). A growing number of studies have reported a beneficial effect of portable air cleaners (PACs) on systolic and diastolic BP; SBP and DBP. We conducted an updated systematic review and meta-analysis of studies using true versus sham mode filtration reporting the effects on BP. Of 214 articles identified up to February 5, 2023, seventeen (from China, USA, Canada, South Korea and Denmark) enrolling approximately 880 participants (484 female) met the inclusion criteria for meta-analyses. Aside from studies conducted in China, research on PACs and BP has been conducted in relatively low pollution settings. Mean indoor PM2.5 concentrations during the active and sham mode purification were 15.9 and 41.2 µg/m3, respectively. The mean efficiency of PACs against indoor PM2.5 was 59.8 % (ranging from 23 % to 82 %). True mode filtration was associated with a pooled mean difference of - 2.35 mmHg (95 % confidence interval [CI]: - 4.5, - 0.2) and - 0.81 mmHg (95 % CI: - 1.86, 0.24) in SBP and DBP, respectively. After removing the studies with high risk of bias, the magnitude of the pooled benefits on SBP and DBP increased to - 3.62 mmHg (95 % CI: - 6.69, - 0.56) and - 1.35 mmHg (95 % CI: - 2.29, - 0.41), respectively. However, there are several barriers to the use of PACs, specifically in low- and middle-income countries (LMICs), such as the initial purchase cost and filter replacements. There may be several avenues to help overcome these economic burdens and improve cost effectiveness, such as implementing government or other subsidized programs to distribute PACs targeting vulnerable and higher-risk individuals. We propose that environmental health researchers and healthcare providers should be better trained to educate the public regarding the use of PACs to reduce the impacts of PM2.5 on cardiometabolic diseases globally.

Association of joint exposure to various ambient air pollutants during adolescence with blood pressure in young adulthood

The association of various air pollutants exposure during adolescence with blood pressure (BP) in young adulthood is uncertain. We intended to evaluate the long-term association of individual and joint air pollutants exposure during adolescence with BP in young adulthood. This cross-sectional study of incoming students was conducted in five geographically disperse universities in China during September and October 2018. Mean concentrations of particulate matter with diameters ≤2.5 μm (PM2.5 ), ≤10 μm (PM10 ), nitrogen dioxides (NO2 ), carbon monoxide (CO), sulfur dioxide (SO2 ), and ozone (O3 ) at participants' residential addresses during 2013-2018 were collected from the Chinese Air Quality Reanalysis dataset. Generalized linear mixed models (GLM) and quantile g-computation (QgC) models were utilized to estimate the association between individual and joint air pollutants exposure and systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP). A total of 16,242 participants were included in the analysis. The GLM analyses showed that PM2.5 , PM10 , NO2 , CO, and SO2 were significantly positively associated with SBP and PP, while O3 was positively associated with DBP. The QgC analyses indicated that long-term exposure to a mixture of the six air pollutants had a significant positive joint association with SBP and PP. In conclusion, air pollutant co-exposure during adolescence may influence BP in young adulthood. The findings of this study emphasized the impacts of multiple air pollutants interactions on potential health and the need of minimizing pollution exposures in the environment.

Ambient air pollution and the health-related quality of life of older adults: Evidence from Shandong China

Ambient air pollution is a major public health concern impacting all aspects of human health. There is a lack of studies on the impact of ambient air pollution on health-related quality of life (HRQoL) of older Chinese adults. Our study answers two questions: How concentrations of ambient air pollutants are associated with HRQoL among older adults in China and, second, what are the possible mechanisms through which ambient air pollution affects HRQoL. From the 2018 National Health Service Survey, we sampled 5717 aged 65 years or older residents for the eastern province of Shandong, China. Data on individual exposures to PM_2.5 and PM₁₀ (particulate matter with diameter less than or equal to 2.5 μm and 10 μm) and sulfur dioxide (SO₂) were collected from the ChinaHighAirPollutants (CHAP) datasets. Mixed-effects Tobit regression models and mixed-effects ordered Probit regression models were employed to examine the associations of long-term exposure to ambient air pollution with the European Quality of Life 5 Dimensions 3 Level Version (EQ-5D-3L) scale comprising mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Socioeconomic, demographic and behavioral factors relating to HRQoL were also examined. The results show that for each 1 μg/m³ increase, EQ-5D-3L scores fell 0.002 for PM_2.5; 0.001 for PM₁₀ and 0.002 for SO₂. Long term exposure to PM_2.5, PM₁₀ and SO₂ were also associated with increased prevalence of pain/discomfort and anxiety/depression. The reduced HRQoL effects of ambient air pollution were exacerbated by higher socioeconomic status (affluent, urban and higher level of education). Our findings suggested that HRQoL of older Chinese adults was not only associated with demographic, socioeconomic, and health-related factors, but also negatively correlated with air pollution, especially through increased pain/discomfort and anxiety/depression. The paper proposes policy recommendations.

Air Pollution, Built Environment, and Early Cardiovascular Disease

As the world's population becomes increasingly urbanized, there is growing concern about the impact of urban environments on cardiovascular health. Urban residents are exposed to a variety of adverse environmental exposures throughout their lives, including air pollution, built environment, and lack of green space, which may contribute to the development of early cardiovascular disease and related risk factors. While epidemiological studies have examined the role of a few environmental factors with early cardiovascular disease, the relationship with the broader environment remains poorly defined. In this article, we provide a brief overview of studies that have examined the impact of the environment including the built physical environment, discuss current challenges in the field, and suggest potential directions for future research. Additionally, we highlight the clinical implications of these findings and propose multilevel interventions to promote cardiovascular health among children and young adults.

Association of SO2/CO exposure and greenness with high blood pressure in children and adolescents: A longitudinal study in China

Introduction

We aimed to investigate the association between greenness around schools, long-term gaseous air pollution exposure (SO₂ and CO), and blood pressure in children and adolescents.

Methods

From 2006 to 2018, a total of 219,956 Chinese children and adolescents aged 7-17 years in Beijing and Zhongshan were included in this longitudinal study. Annual average concentrations of SO₂ and CO and the mean values of normalized difference vegetation index around schools were calculated. We used the generalized estimation equation model, restricted cubic spline model, and Cox model to analyze the health effects.

Results

Among all the subjects, 52,515 had the first onset of HBP. During the follow-up, HBP's cumulative incidence and incidence density were 23.88% and 7.72 per 100 person-year respectively. Exposures to SO₂ and CO were significantly associated with SBP [β = 1.30, 95% CI: (1.26, 1.34) and 0.78 (0.75, 0.81)], DBP [β = 0.81 (0.79, 0.84) and 0.46 (0.44, 0.48)] and HBP [HR = 1.58 (1.57, 1.60) and 1.42 (1.41, 1.43)]. The risks of HBP attributed to SO₂ and CO pollution would be higher in school-aged children in the low greenness group: the attributable fractions (AFs) were 26.31% and 20.04%, but only 13.90% and 17.81% in the higher greenness group. The AFs were also higher for normal-BMI children and adolescents in the low greenness group (AFs = 30.90% and 22.64%, but 14.41% and 18.65% in the high greenness group), while the AFs were not as high as expected for obese children in the low greenness group (AFs = 10.64% and 8.61%), nor was it significantly lower in the high greenness group (AFs = 9.60% and 10.72%).

Discussion

Greenness could alleviate the damage effects of SO₂/CO exposure on the risks of HBP among children and adolescents, and the benefit is BMI sensitivity. It might offer insights for policymakers in making effective official interventions to prevent and control the prevalence of childhood HBP and the future disease burden caused by air pollution.

Pre- and postnatal particulate matter exposure and blood pressure in children and adolescents: A systematic review and meta-analysis

BACKGROUND

Early life is a susceptible period of air pollution-related adverse health effects. Hypertension in children might be life-threatening without prevention or treatment. Nevertheless, the causative association between environmental factors and childhood hypertension was limited. In the light of particulate matter (PM) as an environmental risk factor for cardiovascular diseases, this study investigated the association of pre- and postnatal PM exposure with blood pressure (BP) and hypertension among children and adolescents.

METHOD

Four electronic databases were searched for related epidemiological studies published up to September 13, 2022. Stata 14.0 was applied to examine the heterogeneity among the studies and evaluate the combined effect sizes per 10 μg/m³ increase of PM by selecting the corresponding models. Besides, subgroup analysis, sensitivity analysis, and publication bias test were also conducted.

RESULTS

Prenatal PM_2.5 exposure was correlated with increased diastolic blood pressure (DBP) in offspring [1.14 mmHg (95% CI: 0.12, 2.17)]. For short-term postnatal exposure effects, PM_2.5 (7-day average) was significantly associated with systolic blood pressure (SBP) [0.20 mmHg (95% CI: 0.16, 0.23)] and DBP [0.49 mmHg (95% CI: 0.45, 0.53)]; and also, PM₁₀ (7-day average) was significantly associated with SBP [0.14 mmHg (95% CI: 0.12, 0.16)]. For long-term postnatal exposure effects, positive associations were manifested in SBP with PM_2.5 [β = 0.44, 95% CI: 0.40, 0.48] and PM₁₀ [β = 0.35, 95% CI: 0.19, 0.51]; DBP with PM₁ [β = 0.45, 95% CI: 0.42, 0.49], PM_2.5 [β = 0.31, 95% CI: 0.27, 0.35] and PM₁₀ [β = 0.32, 95% CI: 0.19, 0.45]; and hypertension with PM₁ [OR = 1.43, 95% CI: 1.40, 1.46], PM_2.5 [OR = 1.65, 95% CI: 1.29, 2.11] and PM₁₀ [OR = 1.26, 95% CI: 1.09, 1.45].

CONCLUSION

Both prenatal and postnatal exposure to PM can increase BP, contributing to a higher prevalence of hypertension in children and adolescents.

Evaluating the short-term effect of ambient temperature on non-fatal outdoor falls and road traffic injuries among children and adolescents in China: a time-stratified case-crossover study

Although studies have suggested that non-optimal temperatures may increase the risk of injury, epidemiological studies focusing on the association between temperature and non-fatal injury among children and adolescents are limited. Therefore, we investigated the short-term effect of ambient temperature on non-fatal falls and road traffic injuries (RTIs) among students across Jiangsu Province, China. Meteorological data and records of non-fatal outdoor injuries due to falls and RTIs among students aged 6-17 were collected during 2018-2020. We performed a time-stratified case-crossover analysis with a distributed lag nonlinear model to examine the effect of ambient temperature on the risk of injury. Individual meteorological exposure was estimated based on the address of the selected school. We also performed stratified analyses by sex, age, and area. A total of 57322 and 5455 cases of falls and RTIs were collected, respectively. We observed inverted U-shaped curves for temperature-injury associations, with maximum risk temperatures at 18 °C (48th of daily mean temperature distribution) for falls and 22 °C (67th of daily mean temperature distribution) for RTIs. The corresponding odds ratios (95% confidence intervals) were 2.193 (2.011, 2.391) and 3.038 (1.988, 4.644) for falls and RTIs, respectively. Notably, there was a significant age-dependent trend in which the temperature effect on falls was greater in older students (P-trend < 0.05). This study suggests a significant association between ambient temperature and students' outdoor falls and RTIs. Our findings may help advance tailored strategies to reduce the incidence of outdoor falls and RTIs in children and adolescents.

ELECTRONIC SUPPLEMENTARY MATERIAL

Supplementary material is available in the online version of this article at 10.1007/s11783-023-1705-1 and is accessible for authorized users.

Association between long-term exposure to ambient particulate matter and blood pressure, hypertension: an updated systematic review and meta-analysis

Evidence of more recent studies should be updated to evaluate the effect of long-term exposure to particulate matter (PM) on blood pressure and hypertension.        Studies of long-term effects of PM₁, PM_2.5 and PM₁₀ on blood pressure (SBP, DBP, MAP), hypertension were searched in Pubmed, Web of Science and Embase before May, 2021. Meta-analysis of 41 studies showed that exposure to PM₁, PM_2.5 was associated with SBP (1.76 mmHg (95%CI:0.71, 2.80) and 0.63 mmHg (95%CI:0.40, 0.85), per 10 μg/m³ increase in PM), all three air pollutants (PM₁, PM_2.5, PM₁₀) was associated with DBP (1.16 mmHg (95%CI:0.34, 1.99), 0.31 mmHg (95%CI:0.16, 0.47), 1.17 mmHg (95%CI:0.24, 2.09), respectively. As for hypertension, PM₁, PM_2.5 and PM₁₀ were all significantly associated with higher risk of hypertension (OR=1.27 (95%CI:1.06, 1.52), 1.15 (95%CI:1.10, 1.20) and 1.11 (95%CI:1.07, 1.16). In conclusion, our study indicated a positive association between long-term exposure to particulate matter and increased blood pressure, hypertension.

Long-term exposure to fine particulate matter modifies the association between physical activity and the risk of hypertension

The trade-off between the potentially detrimental effects of fine particulate matter (PM_2.5) and the benefits of physical activity (PA) is unclear. We aimed to explore the independent and interaction effects between long-term PM_2.5 exposure and PA on blood pressure (BP) and hypertension. A total of 8704 adults (≥45 years) without hypertension at baseline in a nationwide cohort of the China Health and Retirement Longitudinal Study (CHARLS) were followed from 2011 to 2015. The participants were selected using a four-stage, stratified, and cluster sampling procedure. The annual PM_2.5 concentrations at the residential address were estimated from a two-stage machine learning model with a 10 km × 10 km resolution. A standard questionnaire collected information on PA and potential confounders, and metabolic equivalents (MET·h/wk), which combined frequency, intensity, and duration information, were used to assess PA levels. We adopted mixed-effects regression models to explore the independent and interaction effects between long-term PM_2.5 exposure and PA on BP and risk of hypertension. Systolic blood pressure (SBP) decreased by -0.84 mmHg (95% CI: -1.34, -0.34) per an IQR (interquartile range, 175.5 MET·h/wk) increase in PA, and diastolic blood pressure (DBP) decreased by -0.42 mmHg (95% CI: -0.76, -0.07). Each IQR (36.1 μg/m³) increment in PM_2.5 was associated with 0.48 mmHg (95% CI: -0.24, 1.20) in SBP and -0.02 mmHg (95% CI: -0.44, 0.39) in DBP. PM_2.5 showed an elevated effect with risks of hypertension (odds ratio, OR = 1.01; 95% CI: 1.00, 1.03), while PA showed the inverse result (OR = 0.98; 95% CI: 0.97, 0.99). Interaction analyses indicated PA maintained the beneficial effects on BP, but the negative association was attenuated, accompanied by the increase of PM_2.5. PA decreased the BP and hypertension risks, while PM_2.5 showed the opposite results. PM_2.5 attenuated the beneficial effects of PA on BP and modified the association between PA and the risk of hypertension.

Long-term effects of ambient PM2.5 constituents on metabolic syndrome in Chinese children and adolescents

Metabolic syndrome (MetS) is considered a main public health issue as it remarkably adds the risk of cardiovascular disease, leading to a heavy burden of disease. There is growing evidence linking fine particulate matter (PM_2.5) exposure to MetS. However, the influences of PM_2.5 constituents, especially in children and adolescents, remain unclear. Our study was according to a national analysis among Chinese children and adolescents to examine the associations between long-term exposure to PM_2.5 main constituents and MetS. A total of 10,066 children and adolescents aged 10-18 years were recruited in 7 provinces in China, with blood tests, health exams, and questionnaire surveys. We estimated long-term exposures to PM_2.5 mass and its five constituents, containing black carbon (BC), organic matter (OM), inorganic nitrate (NO₃^-), sulfate (SO₄^2-), and soil particles (SOIL) from multi-source data fusion models. Mixed-effects logistic regression models were used with the adjustment of a variety of covariates. In the surveyed populations, 2.9% were classified as MetS. From the single-pollutant models, we discovered that long-term exposures to PM_2.5 mass, BC, OM, NO₃^-, as well as SO₄^2-, were significantly associated with the prevalence of MetS, with odds ratios (ORs) per 1 μg/m³ that were 1.02 (95% confidence interval (CI): 1.01, 1.03) for PM_2.5 mass, 1.24 (95% CI: 1.14, 1.35) for BC, 1.07 (95% CI: 1.04, 1.11) for OM, 1.09 (95% CI: 1.04, 1.13) for NO₃^-, and 1.14 (95% CI:1.04, 1.24) for SO₄^2-. The influence of BC on the prevalence of MetS was robust in both the multi-pollutant model and the PM_2.5-constituent joint model. The paper indicates long-term exposure to PM_2.5 mass and specific PM_2.5 constituents, particularly for BC, was significantly associated with a higher MetS prevalence among children and adolescents in China. Our results highlight the significance of establishing further regulations on PM_2.5 constituents.

Associations between air pollutants and blood pressure in an ethnically diverse cohort of adolescents in London, England

Longitudinal evidence on the association between air pollution and blood pressure (BP) in adolescence is scarce. We explored this association in an ethnically diverse cohort of schoolchildren. Sex-stratified, linear random-effects modelling was used to examine how modelled residential exposure to annual average nitrogen dioxide (NO2), particulate matter (PM2.5, PM10) and ozone (O3), measures in μg/m3, associated with blood pressure. Estimates were based on 3,284 adolescents; 80% from ethnic minority groups, recruited from 51 schools, and followed up from 11-13 to 14-16 years old. Ethnic minorities were exposed to higher modelled annual average concentrations of pollution at residential postcode level than their White UK peers. A two-pollutant model (NO2 & PM2.5), adjusted for ethnicity, age, anthropometry, and pubertal status, highlighted associations with systolic, but not diastolic BP. A μg/m3 increase in NO2 was associated with a 0.30 mmHg (95% CI 0.18 to 0.40) decrease in systolic BP for girls and 0.19 mmHg (95% CI 0.07 to 0.31) decrease in systolic BP for boys. In contrast, a 1 μg/m3 increase in PM2.5 was associated with 1.34 mmHg (95% CI 0.85 to 1.82) increase in systolic BP for girls and 0.57 mmHg (95% CI 0.04 to 1.03) increase in systolic BP for boys. Associations did not vary by ethnicity, body size or socio-economic advantage. Associations were robust to adjustments for noise levels and lung function at 11-13 years. In summary, higher ambient levels of NO2 were associated with lower and PM2.5 with higher systolic BP across adolescence, with stronger associations for girls.

Association of Ambient Air Pollution with Blood Pressure in Adolescence: A Systematic-review and Meta-analysis

We systematically reviewed the association of ambient air pollution with blood pressure (BP) as a primary outcome in adolescents (10-19 years). Five databases (Ovid Medline, Ovid Embase, Web of Science, The Cochrane Library, and LILACS) were searched for relevant articles published up to August 2022. Meta-analyses were conducted using STATA v17 (Protocol - OSF Registries https://doi.org/10.17605/OSF.IO/96G5Q). Eight studies (5 cohort, 3 cross-sectional) with approximately 15,000 adolescents were included. Data from 6 studies were suitable for inclusion in the meta-analyses. In sub-group analyses, non-significant positive associations were observed for cohort studies assessing long-term exposure to PM₁₀, PM_2.5, and NO₂ on systolic and diastolic BP. At age 12 years old (3702 adolescents), we found significant positive associations for long-term exposure to PM_2.5(β=5.33 (1.56, 9.09) mmHg) and PM₁₀ (β=2.47 (0.10, 4.85) mmHg) on diastolic BP. Significant positive associations were observed (3,592 adolescents) for long-term exposure to PM₁₀(β=0.34 (0.19, 0.50) mmHg) and NO₂ on diastolic BP (β=0.40 (0.09, 0.71) mmHg), and PM₁₀ on systolic BP (β=0.48 (0.19, 0.77) mmHg). The overall quality of evidence analysed was graded as "low/very low." Insufficient data for short-term exposures to PM₂.₅, PM₁₀, NO₂, CO on BP led to their exclusion from the meta-analysis. Inconsistent associations were reported for gender-stratified results. The evidence, though of low-quality and limited, indicated that ambient air pollution was positively associated with adolescent BP. Future studies need improved measures of air pollutant exposures, consideration of gender and socio-economic circumstances on the observed pollution effects, as well as adjustment for other potential confounding factors.

Life-course exposure to ambient fine particulate matter and hypertension in adulthood: a longitudinal cohort study

PM_2.5-hypertension association were well documented in adults, while the effects of life-course exposure to PM_2.5 on adulthood hypertension remained unclear. This study aimed to investigate the associations between life-course exposure to ambient PM_2.5 and incident hypertension in adulthood in Asia. We included 4272 participants with 17,814 medical visits from two open cohorts in Taiwan and Hong Kong between 2000 and 2018. We used a satellite-based model to assess 2-year average PM_2.5 exposure at a resolution of 1 km². A linear mixed model was used to examine the association with blood pressure. A Cox regression model with time-dependent covariates was used to examine the overall association with the development of hypertension in adulthood. Life-course mixed models were used to examine the effects of PM_2.5 exposure at different life stages on blood pressure and hypertension. For every 10 μg/m³ increase in PM_2.5, the overall risk of adulthood hypertension increased by 40% (95% confidence interval [CI] 8-80%). The health effects of PM_2.5 exposure at different life-stages on incident hypertension were generally independent of each other. In critical model, the risk of developing hypertension increased 23%, 27%, and 55% for each 10 μg/m³ increase in PM_2.5 exposure during school age, adolescence, and adulthood, respectively. Similar associations were found between life-course PM_2.5 exposure and blood pressure. Association between PM_2.5 and adulthood hypertension can be traced back to childhood. Our study suggests that life-course control of air pollution exposure should be implemented to alleviate the huge burden of adulthood hypertension.

Associations of long-term exposure to air pollution, physical activity with blood pressure and prevalence of hypertension: the China Health and Retirement Longitudinal Study

Background

Long-term exposure to air pollution and physical activity (PA) are linked to blood pressure and hypertension. However, the joint effect of air pollution and PA on blood pressure and hypertension are still unknown in Chinese middle-aged and older adults.

Methods

A total of 14,622 middle-aged and older adults from the China Health and Retirement Longitudinal Study wave 3 were included in this study. Ambient air pollution [particulate matter with diameter ≤ 2.5 μm (PM_2.5), or ≤10 μm (PM₁₀), sulfur dioxide (SO₂), nitrogen dioxide (NO₂), carbonic oxide (CO)] were estimated using satellite-based spatiotemporal models. PA was investigated using International Physical Activity Questionnaire. Generalized linear models were used to examine the associations of air pollution, PA score with blood pressure [systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP)], and the prevalence of hypertension. Subgroup analysis was conducted to investigate the effects of air pollution on blood pressure and the prevalence of hypertension in different PA groups.

Results

The results showed that for each inter-quartile range (IQR) increase in PM_2.5 (25.45 μg/m³), PM₁₀ (40.56 μg/m³), SO₂ (18.61 μg/m³), NO₂ (11.16 μg/m³), CO (0.42 mg/m³) and PA score (161.3 MET/h-week), the adjusted odd ratio (OR) of hypertension was 1.207 (95% confidence interval (CI): 1.137, 1.281), 1.189 (95%CI: 1.122, 1.260), 1.186 (95%CI: 1.112, 1.266), 1.186 (95%CI: 1.116, 1.260), 1.288 (95%CI: 1.223, 1.357), 0.948 (95%CI: 0.899, 0.999), respectively. Long-term exposure to PM_2.5, PM₁₀, SO₂, NO₂, and CO was associated with increased SBP, DBP, and MAP levels. For example, each IQR increase in PM_2.5 was associated with 1.20 mmHg (95%CI: 0.69, 1.72) change in SBP, 0.66 mmHg (95%CI: 0.36, 0.97) change in DBP, and 0.84 mmHg (95%CI: 0.49, 1.19) change in MAP levels, respectively. Each IQR increase in PA score was associated with -0.56 mmHg (95%CI: -1.03, -0.09) change in SBP, -0.32 mmHg (95%CI: -0.59, -0.05) change in DBP, and -0.33 mmHg (95%CI: -0.64, -0.02) change in MAP levels, respectively. Subgroup analysis found that the estimated effects in the sufficient PA group were lower than that in the insufficient PA group.

Conclusion

Long-term exposure to air pollutants is associated with increased blood pressure and hypertension risk, while high-level PA is associated with decreased blood pressure and hypertension risk. Strengthening PA might attenuate the adverse effects of air pollution on blood pressure and hypertension risk.

The pathophysiological and molecular mechanisms of atmospheric PM2.5 affecting cardiovascular health: A review

BACKGROUND

Exposure to ambient fine particulate matter (PM2.5, with aerodynamic diameter less than 2.5 µm) is a leading environmental risk factor for global cardiovascular health concern.

OBJECTIVE

To provide a roadmap for those new to this field, we reviewed the new insights into the pathophysiological and cellular/molecular mechanisms of PM2.5 responsible for cardiovascular health.

MAIN FINDINGS

PM2.5 is able to disrupt multiple physiological barriers integrity and translocate into the systemic circulation and get access to a range of secondary target organs. An ever-growing body of epidemiological and controlled exposure studies has evidenced a causal relationship between PM2.5 exposure and cardiovascular morbidity and mortality. A variety of cellular and molecular biology mechanisms responsible for the detrimental cardiovascular outcomes attributable to PM2.5 exposure have been described, including metabolic activation, oxidative stress, genotoxicity, inflammation, dysregulation of Ca2+ signaling, disturbance of autophagy, and induction of apoptosis, by which PM2.5 exposure impacts the functions and fates of multiple target cells in cardiovascular system or related organs and further alters a series of pathophysiological processes, such as cardiac autonomic nervous system imbalance, increasing blood pressure, metabolic disorder, accelerated atherosclerosis and plaque vulnerability, platelet aggregation and thrombosis, and disruption in cardiac structure and function, ultimately leading to cardiovascular events and death. Therein, oxidative stress and inflammation were suggested to play pivotal roles in those pathophysiological processes.

CONCLUSION

Those biology mechanisms have deepen insights into the etiology, course, prevention and treatment of this public health concern, although the underlying mechanisms have not yet been entirely clarified.

The Association between Air Pollutants Exposure with Pre- and Hypertension by Vitamin C Intakes in Korean Adults: A Cross-Sectional Study from the 2013-2016 Korea National Health and Nutrition Examination

OBJECTIVES

Oxidative stress and systemic inflammation are the main pathways by which air pollutants cause hypertension (HTN). Vitamin C intake may reduce the risk of HTN caused by air pollutants. This study aimed to investigate the association between air pollutants and pre-HTN and HTN in Korean adults and whether these associations were modified by vitamin C intake, using data from the 2013-2016 Korean National Health and Nutrition Examination Survey (KNHANES).

DESIGN

Cross-sectional study.

SETTING

This study used data from the KNHANES VI (2013-2015) and VII (2016) along with the data from the annual air pollution report of the Ministry of Environment.

PARTICIPANTS

We included 11,866 adults who had responded to a semi-food frequency questionnaire.

MEASUREMENTS

We used survey logistic regression models to evaluate the association of ambient PM10, SO2, NO2, CO, and O3 with pre-HTN and HTN according to vitamin C intake.

RESULTS

After adjusting for potential covariates, exposure to ambient PM10, SO2, NO2, and CO was significantly associated with a high prevalence of pre-HTN and HTN, whereas exposure to O3 was significantly associated with a low prevalence of pre-HTN and HTN. In particular, as the air pollutant scores increased (severe air pollution), the prevalence of pre-HTN and HTN increased in a dose-dependent manner (highest score vs. lowest score, OR=1.85, 95% CI=1.39-2.46, p for trend <.0001). However, these associations were found to be pronounced in adults with low vitamin C intake (highest score vs. lowest score, OR=2.30, 95% CI=1.50-3.54, p for trend <.0001), whereas the statistical significance disappeared for adults with high vitamin C intake (highest score vs. lowest score, OR=1.40, 95% CI=0.93-2.12, p for trend=0.007).

CONCLUSION

Exposure to air pollutants such as PM10, SO2, NO2, and CO may increase the prevalence of pre-HTN and HTN among Korean adults. In addition, a high intake of vitamin C may help prevent pre-HTN and HTN caused by air pollutants.

Relationship between Built-Up Environment, Air Pollution, Activity Frequency and Prevalence of Hypertension-An Empirical Analysis from the Main City of Lanzhou

In the process of promoting the strategy of a healthy China, the built environment, as a carrier of human activities, can effectively influence the health level of residents in the light of its functional types. Based on the POI data of four main urban areas in Lanzhou, this paper classifies the built environment in terms of function into four types. The association between different types of built environments and the prevalence of hypertension was investigated by using the community as the study scale, and activity frequency, air pollution and green space were used as mediating variables to investigate whether they could mediate the relationship between built environments and hypertension. The results indicate that communities with a high concentration of commercial service facilities, road and traffic facilities and industrial facilities have a relatively high prevalence of hypertension. By determining the direct, indirect and overall effects of different functional types of built environment on the prevalence of hypertension, it was learned that the construction of public management and service facilities can effectively mitigate the negative effects of hypertension in the surrounding residents. The results of the study contribute to the rational planning of the structure of the built environment, which is beneficial for optimizing the urban structure and preventing and controlling chronic diseases such as hypertension.

The impact of prolonged exposure to air pollution on the incidence of chronic non-communicable disease based on a cohort in Tianjin

Evidence on the associations of prolonged ambient pollutants exposure with chronic non-communicable diseases among middle-aged and elderly residents is still limited. This prospective cohort study intends to investigate the long-term effects of ambient pollution on hypertension and diabetes incidence among relatively older residents in China. Individual particulate matter exposure levels were estimated by satellite-based model. Individual gaseous pollutants exposure levels were estimated by Inverse Distance Weighted model. A Cox regression model was employed to assess the risks of hypertension and diabetes morbidity linked to air pollutants exposures. The cross-product term of ambient pollutants exposure and covariates was further added into the regression model to test whether covariates would modify these air pollution-morbidity associations. During the period from 2014 to 2018, a total of 97,982 subjects completed follow-up. 12,371 incidents of hypertension and 2034 of diabetes occurred. In the multi-covariates model, the hazard ratios (HR) and 95% confidence interval (CI) were 1.49 (1.45-1.52), 1.28 (1.26-1.30), 1.17 (1.15-1.18), 1.21 (1.17-1.25) and 1.33 (1.31-1.35) for hypertension morbidity per 10 μg/m³ increment in PM₁, PM_2.5, PM₁₀, NO₂ and SO₂, respectively. For diabetes onsets, the HR (95% CI) were 1.17 (1.11-1.23), 1.09 (1.04-1.13), 1.06 (1.02-1.09), 1.02 (0.95-1.10), and 1.24 (1.19-1.29), respectively. In addition, for hypertension analyses, the effect estimates were more pronounced in the participants with age <60 years old, BMI ≥24 kg/m², and frequent alcohol drinking. These findings provided the evidence on elevated risks of morbidity of hypertension and diabetes associated with prolonged ambient pollutants exposure at relatively high levels.

Overview of particulate air pollution and human health in China: Evidence, challenges, and opportunities

Ambient particulate matter (PM) pollution in China continues to be a major public health challenge. With the release of the new WHO air quality guidelines in 2021, there is an urgent need for China to contemplate a revision of air quality standards (AQS). In the recent decade, there has been an increase in epidemiological studies on PM in China. A comprehensive evaluation of such epidemiological evidence among the Chinese population is central for revision of the AQS in China and in other developing countries with similar air pollution problems. We thus conducted a systematic review on the epidemiological literature of PM published in the recent decade. In summary, we identified the following: (1) short-term and long-term PM exposure increase mortality and morbidity risk without a discernible threshold, suggesting the necessity for continuous improvement in air quality; (2) the magnitude of long-term associations with mortality observed in China are comparable with those in developed countries, whereas the magnitude of short-term associations are appreciably smaller; (3) governmental clean air policies and personalized mitigation measures are potentially effective in protecting public and individual health, but need to be validated using mortality or morbidity outcomes; (4) particles of smaller size range and those originating from fossil fuel combustion appear to show larger relative health risks; and (5) molecular epidemiological studies provide evidence for the biological plausibility and mechanisms underlying the hazardous effects of PM. This updated review may serve as an epidemiological basis for China’s AQS revision and proposes several perspectives in designing future health studies.

•

Acute effects of PM are smaller in China compared with developed countries

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Health effects caused by PM depend on particle composition, source, and size

•

There are no thresholds for the health effects of PM

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Mechanistic studies support the biological plausibility of PM’s health effects

Associations of residential greenness with obesity and BMI level among Chinese rural population: findings from the Henan Rural Cohort Study

In recent years, increasing evidence supports the notion that obesity risk is affected by residential greenness. However, limited studies have been established in low- and middle-income countries, especially in China. The study aimed to evaluate the associations of residential greenness with obesity and body mass index (BMI) level in Chinese rural-dwelling adults. A total of 39,259 adults from the Henan Rural Cohort Study (HRCS) were included in the analyses. According to the guideline for prevention and control of overweight and obesity in Chinese adults, obesity was defined as BMI ≥ 28 kg/m². Residential greenness was measured by satellite-based normalized difference vegetation index (NDVI) and enhanced vegetation index (EVI). Generalized linear mixed models were used to study the associations between exposure to residential greenness with obesity and BMI level. Higher residential greenness was significantly correlated with lower odds of obesity and BMI level. For example, in the full-adjusted analyses, an interquartile range (IQR) increase in EVI_500-m was linked with reduced odds of obesity (OR = 0.77, 95%CI 0.72-0.82) and BMI level (β =  - 0.41 kg/m², 95%CI - 0.48 to - 0.33 kg/m²). Mediation analyses showed air pollution and physical activity could be potential mediators in these associations. Besides, we found that the association of NDVI_500-m with BMI was stronger in females and low-income populations. Higher residential greenness was associated with a lower prevalence of obesity and BMI level, particularly among females and the low-income population. These relationships were partially mediated by reducing air pollution and increasing physical activity.

Associations of long-term ambient air pollution and traffic-related pollution with blood pressure and hypertension defined by the different guidelines worldwide: the CHCN-BTH study

The assessment of the generalization of the strict hypertension definition in the 2017 ACC/AHA Hypertension Guideline from environmental condition remains sparse. The aims of this study are to investigate and compare the associations of ambient air pollution and traffic-related pollution (TRP) with hypertension defined by the different criteria. A total of 32,135 participants were recruited from the baseline survey of the CHCN-BTH in 2017. We defined hypertension as SBP/DBP ≥ 140/90 mmHg according to the hypertension guidelines in China, Japan, Europe and ISH (traditional criteria) and defined as SBP/DBP ≥ 130/80 mmHg according to the 2017 ACC/AHA Hypertension Guideline (strict criteria). A two-level generalized linear mixed models were applied to investigate the associations of air pollutants (i.e. PM_2.5, SO₂, NO₂) and TRP with blood pressure (BP) measures and hypertension. Stratified analyses and two-pollutant models were also performed. The stronger associations of air pollutants were found in the hypertension defined by the strict criteria than that defined by the traditional criteria. The ORs per an IQR increase in PM_2.5 were 1.17 (95% CI: 1.09, 1.25) for the strict criteria and 1.14 (95% CI: 1.06, 1.23) for the traditional criteria. The similar conditions were also observed for TRP. The above results were robust in both stratified analyses and two-pollutant models. Our study assessed the significance of the hypertension defined by the strict criteria from environmental aspect and called attention to the more adverse effects of air pollution and TRP on the earlier stage of hypertension.

Trends in associations between socioeconomic development and urban-rural disparity with high blood pressure in Chinese children and adolescents over two decades

This study aimed to assess the association between the trend of urban-rural disparity in high blood pressure (HBP) in Chinese children and adolescents and socioeconomic development. Data on 1,054,602 students aged 7-18 years were obtained from five successive national surveys administered in 29 Chinese provinces in 1995, 2000, 2005, 2010, and 2014. HBP was defined as average measured systolic BP and/or diastolic BP equal to or more than 95th percentile. The socioeconomic indicators at the provincial-level included gross domestic product (GDP) per capita, the Engel coefficient, and urbanization rates. From 1995 to 2014, HBP prevalence in Chinese children and adolescents fluctuated between 6.9% and 9.2%. Rural areas had a higher prevalence of HBP than urban areas, with a diminishing trend in urban-rural disparity from 1995 to 2010 with a reduced OR from 1.45 (95% CI: 1.40-150) in 1995 to 1.09 (1.05-1.12) in 2010, whereas a widening gap in 2014 with OR of 1.23 (1.19-1.26)). A positive association existed between the improvement of socioeconomic indicators and the increase in HBP, which was demonstrated obviously by the Engel coefficient strata. The increases in the urbanization rates were accompanied by a greater increase of HBP in urban than in rural areas. The large urban-rural disparity suggests a priority of HBP control in rural children due to their current and future HBP and cardiovascular disease risks. Socioeconomic development could affect the urban-rural disparity in HBP risk, reflecting the importance of effective policy responses for preventing HBP by avoiding unhealthy lifestyles brought about by rapid economic development.

Short- and medium-term air pollution exposure, plasmatic protein levels and blood pressure in children

Exposure to air pollution influences children's health, however, the biological mechanisms underlying these effects are not completely elucidated. We investigated the association between short- and medium-term outdoor air pollution exposure with protein profiles and their link with blood pressure in 1170 HELIX children aged 6-11 years. Different air pollutants (NO₂, PM₁₀, PM_2.5, and PM_2.5abs) were estimated based on residential and school addresses at three different windows of exposure (1-day, 1-week, and 1-year before clinical and molecular assessment). Thirty-six proteins, including adipokines, cytokines, or apolipoproteins, were measured in children's plasma using Luminex. Systolic and diastolic blood pressure (SBP and DBP) were measured following a standardized protocol. We performed an association study for each air pollutant at each location and time window and each outcome, adjusting for potential confounders. After correcting for multiple-testing, hepatocyte growth factor (HGF) and interleukin 8 (IL8) levels were positively associated with 1-week home exposure to some of the pollutants (NO₂, PM₁₀, or PM_2.5). NO₂ 1-week home exposure was also related to higher SBP. The mediation study suggested that HGF could explain 19% of the short-term effect of NO₂ on blood pressure, but other study designs are needed to prove the causal directionality between HGF and blood pressure.

Combining multiaspect factors to predict the risk of childhood hypertension incidence

Childhood hypertension has become a global public health issue due to its increasing prevalence and association with cerebral‐cardiovascular disease in adults. In this study, we developed a predictive model for childhood hypertension based on environmental and genetic factors to identify at‐risk individuals. Eighty children diagnosed with childhood hypertension and 84 children in the control group matched by sex and age from an established cohort were included in a nested case–control study. We constructed a multiple logistic regression model to analyze the factors associated with hypertension and applied the 10‐fold cross‐validation method to verify the prediction stability of the model. Childhood hypertension was found positively correlated with triglyceride level ≥150 mg/dL; low‐density lipoprotein cholesterol level ≥110 mg/dL; body mass index Z score; waist‐to‐height ratio Z score; and red blood cell count (all P < .01) and negatively correlated with the relative expression level of retinol acyltransferase; relative expression level of vitamin D receptor; and dietary intake of fiber, vitamin C and copper (all P < .05) in this study. BMI Z score, triglyceride ≥150 mg/dL, RBC count, VDR/β‐actin and LRAT/β‐actin ratios were used to construct the predictive model. The area under the receiver operating characteristic curve was 94.45% (95% CI = 89.35%∼98.65%, P < .001). The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were all above 80% in both the training and validation sets. In conclusion, this model can predict the risk of childhood hypertension and could provide a theoretical basis for early prevention and intervention to improve the cardiovascular health of children.

Combined toxicity of air pollutants related to e-waste on inflammatory cytokines linked with neurotransmitters and pediatric behavioral problems

E-waste usually refers to the discarded electrical or electronic equipment that is no longer used. Informal e-waste recycling methods, such as burning, roasting, acid leaching, and shredding, had resulted in serious air pollution, which is a prominent risk factor for children's health. However, the combined toxicity of air pollutants on children's behavioral health remains unclear. This study collected data on air pollution exposure, calculated the average daily dose (ADD) based on these air pollutants for children in Guiyu (e-waste group, n = 112) and Haojiang (reference group, n = 101), then assessed children's behavioral health using the Strengths and Difficulties Questionnaire (SDQ), and further estimated the associations of ADD, inflammatory cytokines, neurotransmitters, and children's behavioral problems. Compared with Haojiang, Guiyu has poorer air quality and higher levels of ADD, inflammatory cytokines (such as IL-1β, IL-6, and TNF-α), neurotransmitters (such as DA and SP), and SDQ scores, but lower levels of serum neuropeptide Y (NPY) levels. Spearman correlation analyses indicated that there were significant relationships among inflammatory cytokines, neurotransmitters, and behavioral scores. Multiple linear regression analyses showed that each unit increase in ADD was associated with serum levels of DA and SP, the serum NPY subsequently changed by B (95% CI): 0.99 (0.14, 1.84) nmol/L, 0.25 (0.08, 0.42) ng/mL, and - 0.16 (-0.26, -0.05) ng/mL, respectively. After adjustment for confounders, logistic regression analyses suggested that with each one-fold increase in ADD was associated with the risk of emotional symptoms [OR (95% CI): 18.15 (2.72, 121.06)], hyperactivity-inattention [13.64 (2.28, 81.65)] and total difficulties [8.90 (1.60, 49.35)] and prosocial behavior [- 7.32 (-44.37, -1.21)]. Taken together, this study demonstrates that combined exposure to air pollutants may alter the levels of inflammatory cytokines and serum neurotransmitter to subsequently impact behavioral health in children.

Relationship of indoor solid fuel use for cooking with blood pressure and hypertension among the elderly in China

Indoor air pollution caused by solid fuel use for cooking affects 2.5 billion people worldwide and may elevate blood pressure (BP) and increase the burden of hypertension. Although the elderly are the most at risk of an elevated BP and hypertension, few studies have evaluated the effect of indoor solid fuel use for cooking on BP in persons over the age of 65. Therefore, in this study, we randomly selected 8067 elderly people over 65 years of age from the 2018 Chinese Longitudinal Healthy Longevity Survey to determine the impact of indoor solid fuel use on BP/hypertension. The results showed that, compared with those who cooked with clean fuel, those who cooked with solid fuel had a 1.87 mmHg higher systolic blood pressure, a 0.09 mmHg higher diastolic blood pressure, a 0.97 mmHg higher pulse pressure, and a 1.22 mmHg higher mean arterial pressure. However, we did not find any association between indoor solid fuel use and hypertension. We further observed that northern China residents, women, people aged over 90 years, hypertensive and heart patients, and those with natural ventilation in the kitchen that used indoor solid fuel experienced a greater BP impact. Replacing solid fuel with clean fuel may be an important way to lower BP. Regarding this, priority access to clean fuel should be given to the susceptible population, including the elderly aged ≥ 75 years, northern China residents, women, and hypertensive and heart patients.

Combined oxidant capacity, redox-weighted oxidant capacity and elevated blood pressure: A panel study

BACKGROUND

Evidence is limited on the potential health effects of Ox (sum value) and Oxwt(weighted value), the two surrogates for ozone (O3) and nitrogen dioxides (NO2).

OBJECTIVES

To investigate the impacts of Ox and redox-weighted oxidant capacity (Oxwt) on blood pressure (BP).

METHODS

A panel study was conducted with four repeated follow-up visits among 40 healthy college students in Hefei, Anhui Province, China from August to October, 2021. We measured BP by using an automated sphygmomanometer and obtained hourly data of air pollutants at a nearby site. The sum of O3 and NO2 (Ox) and their weighted average (Oxwt) were obtained as exposure variables. We applied linear mixed-effect models to evaluate the effects of Ox and Oxwton systolic BP (SBP), diastolic BP (DBP), mean arterial pressure (MAP) and pulse pressure (PP).

RESULTS

Totally, 160 pairs of valid BP values were obtained. The 24-h mean levels of Ox and Oxwt were 64.38 μg/m3 and 110.28 μg/m3, respectively. Overall, both Ox and Oxwt were significantly linked with SBP, DBP and MAP at most lag periods, whereas non-significant with PP. A 10-μg/m3 increase in Oxwt at lag 0-24 h was linked to increases of 2.43 mmHg (95% CI: 0.96, 3.91) in SBP, 2.31 mmHg (95% CI: 1.37, 3.26) in DBP and 2.35 mmHg (95% CI: 1.35, 3.36) in MAP, while the corresponding effect estimates for Ox were 1.51 mmHg (95%CI: 0.60, 2.43), 1.43 mmHg (95% CI: 0.85, 2.02) and 1.46 mmHg (95%CI: 0.83, 2.09). In two-pollutant models, our results were almost unchanged after controlling for simultaneous exposure to other pollutants. The effects were more pronounced among males and those with physical activity.

CONCLUSIONS

The findings provide first-hand evidence that short-term exposure to Ox and Oxwt was associated with BP increases in young adults.

Greenness alleviates the effects of ambient particulate matter on the risks of high blood pressure in children and adolescents

Both ambient particulate matter (PM) and decrease of greenness have been suggested as risk factors for high blood pressure (HBP) in children and adolescents. But most evidence were from cross-sectional studies with limited data from prospective cohorts. In this cohort study, we included 588,004 children and adolescents aged 7 to 18 years without HBP from 2005 to 2018 in Beijing (240,081) and Zhongshan (347,923) city of China. The cumulative incidence of HBP was 32.04%, and incidence rate was 14.86 per 100 person-year. After adjustment for confounders, the ten-unit increase in PM₁, PM_2.5, and PM₁₀ exposure was significantly associated with 43%, 70%, and 43%- higher risks of HBP, respectively, but the 0.1-unit increase in NDVI exposure was significantly associated with a 25% lower risk of HBP. The HRs of PM₁ on the HBP risk were 1.486 and 1.150 in the low and the high-level of greenness, and they were 2.635 and 2.507 for PM_2.5, and for PM₁₀ 1.367 and 1.702 in the two groups. The attributable fraction (AFs) of PM₁, PM_2.5, and PM₁₀ on HBP incidents were 13.74%, 40.08%, and 15.47% in the low-level of greenness, which simultaneously was higher than those in the high-level of greenness (AF = 4.62%, 17.28%, and 9.96%). The exposure to higher ambient PM air pollution and lower greenness around schools were associated with a higher risk of HBP in children and adolescents, but higher greenness alleviated the adverse effects of ambient PM₁ and PM_2.5 on the HBP risks. Our findings highlighted a synergic strategy in preventing childhood HBP by decreasing air pollution reduction and improving greenness concurrently.

Associations of combined exposures to ambient temperature, air pollution, and green space with hypertension in rural areas of Anhui Province, China: A cross-sectional study

Hypertension (HTN) was a major preventable cause of cardiovascular disease (CVD), contributing to a huge disease burden. Ambient temperature, air pollution and green space were important influencing factors of HTN, and few studies have assessed the effects and interactions of ambient temperature, air pollution and green space on HTN in rural areas. In this study, we selected 8400 individuals randomly in rural areas of Anhui Province by a multi-stage stratified cluster sampling. A total of 8383 individuals were included in the final analysis. We collected particulate pollutants and meteorological data from the local air quality monitoring stations and National Center for Meteorological Science from January 1 to December 31, 2020, respectively. The normalized differential vegetation index (NDVI) of Anhui Province in 2020 was produced and processed by remote sensing inversion on the basis of medium resolution satellite images. The average annual mean exposure concentrations of air pollution, meteorological factors, and NDVI were calculated for each individual based on the geocoded residential address. HTN was defined according the Chinese Guidelines for Prevention and Treatment of HTN. The effects and interactions of ambient temperature, air pollution and green space on HTN were evaluated by generalized linear model and interaction model, respectively. In this study, the prevalence of HTN was 24.14%. The adjusted odd ratio of HTN for each 1 μg/m³ increasing in PM_2.5 and PM₁₀, 1 °C of ambient temperature, and 0.1 of NDVI were:1.276 (1.013, 1.043), 1.012 (1.006, 1.018), 0.862 (0.862, 0.981) and 0.669 (0.611, 0.733), respectively. The results showed that air pollutants were positively correlated with HTN, while ambient temperature and green space were negatively correlated with HTN. Meanwhile, the negative associations of green space on HTN could decrease with the increasing concentrations of air pollution, but increase with the rising of ambient temperature.

Long-term effects of PM2.5 components on blood pressure and hypertension in Chinese children and adolescents

Growing evidence has linked fine particulate matter (PM_2.5) exposure to elevated blood pressure, but the effects of PM_2.5 components are unclear, particularly in children and adolescents. Based on a cross-sectional investigation in China, we analyzed the associations between long-term exposure to PM_2.5 and its major components with elevated blood pressure in children and adolescents. A representative sample (N = 37,610) of children and adolescents with age 7-18 years was collected in seven Chinese provinces. Exposures to PM_2.5 and five of its major components, including black carbon (BC), organic matter (OM), inorganic nitrate (NO₃^-), sulfate (SO₄^2-), and soil particles (SOIL), were estimated using satellite-based spatiotemporal models. The associations between long-term exposures to PM_2.5 and its components and diastolic blood pressure (DBP), systolic blood pressure (SBP), and hypertension were investigated using mixed-effects logistic and linear regression models. Within the populations, 11.5 % were classified as hypertension. After adjusting for a variety of covariates, per interquartile range (IQR) increment in PM_2.5 mass and BC levels were significantly associated with a higher hypertension prevalence with odds ratios (ORs) of 1.56 (95% confidence interval (CI): 1.08, 2.25) for PM_2.5 and 1.19 (95% CI: 1.04, 1.35) for BC. Long-term exposures to PM_2.5 and BC have also been associated with elevated SBP and DBP. Additionally, OM and NO₃^- were significantly associated with increased SBP, while SOIL was significantly associated with increased DBP. In the subgroup analysis, the associations between long-term exposures to BC and blood pressure vary significantly by urbanicity of residential area and diet habits. Our study suggests that long-term exposure to PM_2.5 mass and specific PM_2.5 components, especially for BC, are significantly associated with elevated blood pressure and a higher hypertension prevalence in Chinese children and adolescents.

Natural and built environments and blood pressure of Alpine schoolchildren

BACKGROUND

Early life environments may influence children's blood pressure (BP), but evidence on the combined effects of natural and built environment exposures is scarce. The present study investigates the associations of natural and built environment indicators, traffic noise, and air pollution with BP in children living in Alpine valleys.

METHODS

In 2004/2005, 1251 school children (8-12 years old) were sampled for a cross-sectional survey in several Austrian and Italian mountain valleys. Children's mothers completed a questionnaire. The outcomes of interest were systolic and diastolic BP measured with a calibrated oscillometric device. Indicators of land cover assigned to the residential and school coordinates within 100 and 1000 m included normalized difference vegetation index (NDVI), tree canopy cover, and a broader naturalness indicator titled distance to nature (D2N). The presence of a home garden was also measured via self-report. Imperviousness density served as a proxy for the built environment. Residential air pollution (NO₂) and noise (L_den) from traffic were calculated using bespoke modeling. NO₂, L_den, physical activity, and body mass index (BMI) were treated as mediating pathways.

RESULTS

Higher NDVI and tree cover levels in residential and school surroundings and home gardens were consistently associated with lower BP. The built environment was associated with higher BP. Counterintuitive inverse associations between NO₂ and L_den and BP were also found. Structural equation modeling showed that higher levels of greenspace and presence of a home garden were weakly associated with more outdoor play spaces, and in turn with lower BMI, and ultimately with lower BP.

CONCLUSIONS

Exposure to natural environments may help maintain normal BP in children, while built environment may increase children's BP. Outdoor play and less adiposity in greener areas may mediate some of these associations. Evidence on air pollution and noise remains controversial and difficult to explain.

Association between long-term exposure to PM2.5 and hypertension: A systematic review and meta-analysis of observational studies

BACKGROUND

Numerous studies have examined the association between long-term exposure to particulate matter with an aerodynamic diameter of ≤2.5 μm (PM_2.5) and hypertension. However, the results are inconsistent.

OBJECTIVES

Considering the limitations of previous meta-analyses and the publication of many new studies in recent years, we conducted this meta-analysis to assess the relationship between long-term PM_2.5 exposure and the incidence and prevalence of hypertension in a healthy population.

METHODS

We searched PubMed, Web of Science, Embase, and Scopus for relevant studies published until April 2, 2021 and reviewed the reference lists of previous reviews. A total of 28 observational studies reporting RR or OR with 95% CI for the association between long-term PM_2.5 exposure and the risk of hypertension were included.

RESULTS

After the sensitivity analysis, we excluded one study with a high degree of heterogeneity, resulting in 27 studies and 28 independent reports. Approximately 42 million participants were involved, and the cases of hypertension in cohort and cross-sectional studies were 508,749 and 1,793,003, respectively. The meta-analysis showed that each 10 μg/m³ increment in PM_2.5 was significantly associated with the risks of hypertension incidence (RR = 1.21, 95% CI: 1.07, 1.35) and prevalence (OR = 1.06, 95% CI: 1.03, 1.09). Subgroup analyses showed that occupational exposure had a significant effect on the association of PM_2.5 and hypertension incidence (p for interaction = 0.042) and that the PM_2.5 concentration level and physical activity had a noticeable effect on the association of PM_2.5 and hypertension prevalence (p for interaction = 0.005; p for interaction = 0.022).

CONCLUSIONS

A significantly positive correlation was observed between long-term PM_2.5 exposure and risks of hypertension incidence and prevalence, and a high PM_2.5 concentration resulted in an increased risk of hypertension.

Effects of household cooking with clean energy on the risk for hypertension among women in Beijing

Outdoor air pollution and indoor burning of biomass fuel can cause high blood pressure. However, little is known about the effects of cooking with clean energy on hypertension. We thus explored whether cooking with clean energy is associated with the risk for hypertension. The study used baseline data from 12,349 women from a large population-based cohort study in Beijing, China. Information on cooking habits, health status, and other characteristics was collected by questionnaire and physical examination. Fasting blood samples were collected to measure total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and homocysteine (HCY). An index of cooking exposure was constructed. Log-binomial regression models were used to estimate the association between cooking exposure and risk for hypertension. The prevalence of hypertension was 26.7%. Any cooking exposure at all was associated with an increased risk for hypertension with an adjusted prevalence ratio (aPR) of 2.27 (95% confidence interval [CI]: 2.01, 2.57). The risk for hypertension increased with increases in cooking frequency, time spent cooking, and the cooking index, all showing a dose-effect relationship (P < 0.001). An increased risk for hypertension was associated with both cooking using mainly electricity (aPR: 1.75, 95% CI: 1.41, 2.17) and cooking using mainly natural gas (aPR: 2.30, 95% CI: 2.03, 2.60). The cooking index was positively correlated with plasma concentrations of TC, TG, LDL-C, and HCY and negatively correlated with HDL-C. Abnormal levels of all these biomarkers were associated with an increased prevalence of hypertension after adjustment for confounding factors. Cooking with clean energy, mainly cooking habit, may contribute to an increased risk for hypertension among female residents of Beijing. Abnormal metabolism of lipids or HCY may be an important mechanism involved in the development of cooking-related hypertension.

The Association Between Long-Term Exposure to Particulate Matter and Incidence of Hypertension Among Chinese Elderly: A Retrospective Cohort Study

Background and Objectives: Studies that investigate the links between particulate matter ≤2. 5 μm (PM_2.5) and hypertension among the elderly population, especially those including aged over 80 years, are limited. Therefore, we aimed to examine the association between PM_2.5 exposure and the risk of hypertension incidence among Chinese elderly. Methods: This prospective cohort study used 2008, 2011, 2014, and 2018 wave data from a public database, the Chinese Longitudinal Healthy Longevity Survey, a national survey investigating the health of those aged over 65 years in China. We enrolled cohort participants who were free of hypertension at baseline (2008) from 706 counties (districts) and followed up in the 2011, 2014, and 2018 survey waves. The annual PM_2.5 concentration of 706 counties (districts) units was derived from the Atmospheric Composition Analysis Group database as the exposure variable, and exposure to PM_2.5 was defined as 1-year average of PM_2.5 concentration before hypertension event occurrence or last interview (only for censoring). A Cox proportional hazards model with penalized spline was used to examine the non-linear association between PM_2.5 concentration and hypertension risk. A random-effects Cox proportional hazards model was built to explore the relationship between each 1 μg/m³, 10 μg/m³ and quartile increment in PM_2.5 concentration and hypertension incidence after adjusting for confounding variables. The modification effects of the different characteristics of the respondents were also explored. Results: A total of 7,432 participants aged 65-116 years were enrolled at baseline. The median of PM_2.5 exposure concentration of all the participants was 52.7 (inter-quartile range, IQR = 29.1) μg/m³. Overall, the non-linear association between PM_2.5 and hypertension incidence risk indicated that there was no safe threshold for PM_2.5 exposure. The higher PM_2.5 exposure, the greater risk for hypertension incidence. Each 1 μg/m³ [adjusted hazard ratio (AHR): 1.01; 95% CI: 1.01-1.02] and 10 μg/m³ (AHR: 1.12; 95% CI: 1.09-1.16) increments in PM_2.5, were associated with the incidence of hypertension after adjusting for potential confounding variables. Compared to first quartile (Q1) exposure, the adjusted HRs of hypertension incidence for the Q2, Q3 and Q4 exposure of PM_2.5 were 1.31 (95% CI: 1.13-1.51), 1.35 (95% CI: 1.15-1.60), and 1.83 (95% CI: 1.53-2.17), respectively. The effects appear to be stronger among those without a pension, living in a rural setting, and located in central/western regions. Conclusion: We found no safe threshold for PM_2.5 exposure related to hypertension risk, and more rigorous approaches for PM_2.5 control were needed. The elderly without a pension, living in rural and setting in the central/western regions may be more vulnerable to the effects of PM_2.5 exposure.

Exposure to particulate matter: a brief review with a focus on cardiovascular effects, children, and research conducted in Turkey

Exposure to environmental particulate matter (PM), outdoor air pollution in particular, has long been associated with adverse health effects. Today, PM has widely been accepted as a systemic toxicant showing adverse effects beyond the lungs. There are numerous studies, from those in vitro to epidemiological ones, suggesting various direct and indirect PM toxicity mechanisms associated with cardiovascular risks, including inflammatory responses, oxidative stress, changes in blood pressure, autonomic regulation of heart rate, suppression of endothelium-dependent vasodilation, thrombogenesis, myocardial infarction, and fibrinolysis. In addition to these and other health risks, considerations about air quality standards should include individual differences, lifestyle, and vulnerable populations such as children. Urban air pollution has been a major environmental issue for Turkey, and this review will also address current situation, research, and measures taken in our country.

The acute effects of particulate matter air pollution on ambulatory blood pressure: A multicenter analysis at the hourly level

Epidemiological evidence from ambulatory blood pressure monitoring is needed to clarify the associations of particulate air pollution with blood pressure and potential lag patterns. We examined the associations of fine and coarse particulate matter (PM_2.5, PM_2.5-10) with ambulatory blood pressure among 7108 non-hypertensive participants from 7 Chinese cities between April 2016 and November 2020. Hourly concentrations of PM_2.5 and PM_2.5-10 were obtained from the nearest monitoring stations. We measured four blood pressure indicators, including systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and pulse pressure (PP). Linear mixed-effect models combined with distributed lag models were applied to analyze the data. Generally, very short-term exposure to PM_2.5 was significantly associated with elevated blood pressure. These effects occurred on the same hour of blood pressure measurement, attenuated gradually, and became insignificant approximately at lag 12 h. An interquartile range (IQR, 33 μg/m³) increase of PM_2.5 was significantly associated with cumulative increments of 0.58 mmHg for SBP, 0.31 mmHg for DBP, 0.38 mmHg for MAP, and 0.33 mmHg for PP over lag 0 to 12 h. The exposure-response relationship curves were almost linear without thresholds, but tended to be flat at very high concentrations. No significant associations were observed for PM_2.5-10. Our study provides independent and robust associations between transient PM_2.5 exposure and elevated blood pressure within the first 12 h, and reinforces the evidence for a linear and non-threshold exposure-response relationship, which may have implications for blood pressure management and hypertension prevention in susceptible population.

Long-term association of ambient air pollution and hypertension in adults and in children: A systematic review and meta-analysis

AIMS

The association of long-term ambient air pollution and hypertension has been inconsistently reported. We performed an updated systematic review and meta-analysis to assess the association between long-term exposure to ambient air pollution and risk of hypertension in adults and in children.

METHODS

PubMed, EMBASE, and Web of Science were searched up to August 7, 2020 for published articles examining the association of long-term exposure to ambient air pollution, including particulate matter (PM; ultrafine particles, PM₁, PM_1-2.5, PM_2.5, PM_2.5-10 and PM₁₀), nitrogen dioxide (NO₂), nitrogen oxides (NO_x), sulfur dioxide (SO₂), ozone (O₃), carbon monoxide (CO) and hypertension. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) for hypertension with each 10-μg/m³ increase in air pollutants were calculated by random-effects models.

RESULTS

We included 57 studies (53 of adults and 4 of children) in the meta-analysis. Risk of hypertension was significantly increased in adults with each 10-μg/m³ increase in exposure to PM_2.5 (OR 1.10, 95% CI 1.07-1.14; I² = 93.1%; n = 37), PM₁₀ (1.04, 1.02-1.07; I² = 44.8%; n = 22), and SO₂ (1.21, 1.08-1.36; I² = 96.6%; n = 3). Hypertension was not significantly associated with PM₁ (n = 2), PM_2.5-10 (n = 16), NO₂ (n = 27), or NO_x (n = 17). In children, the summary ORs (95% CIs) for each 10-μg/m³ increase in PM_2.5, PM₁₀, SO₂ and O₃ were 2.82 (0.51-15.68; I² = 83.8%; n = 2), 1.15 (1.01-1.32; I² = 0; n = 2), 8.57 (0.13-575.58; I² = 94.2%; n = 2), and 1.26 (0.81-1.09, I² = 91.6%; n = 2), respectively.

CONCLUSIONS

Long-term ambient air pollution is a potential risk factor for hypertension in adults. More studies are needed to explore the effects of long-term air pollution on hypertension in children.