Dzhambov Angel M, Tokmakova Mariya P, Gatseva Penka D, Zdravkov Nikolai G, Gencheva Dolina G, Ivanova Nevena G, Karastanev Krasimir I, Vladeva Stefka V, Donchev Aleksandar T, Dermendzhiev Svetlan M
Department of Hygiene and Ecomedicine, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria
Section of Cardiology, First Department of Internal Diseases, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
Folia Med (Plovdiv). 2017 Sep 1;59(3):344-356. doi: 10.1515/folmed-2017-0045.
Road traffic noise (RTN) is a risk factor for cardiovascular disease (CVD) and hypertension; however, few studies have looked into its association with blood pressure (BP) and renal function in patients with prior CVD.
This study aimed to explore the effect of residential RTN exposure on BP and renal function in patients with CVD from Plovdiv Province.
We included 217 patients with ischemic heart disease and/or hypertension from three tertiary hospitals in the city of Plovdiv (March - May 2016). Patients' medical history, medical documentation, and medication regimen were reviewed, and blood pressure and anthropometric measurements were taken. Blood samples were analyzed for creatinine, total cholesterol, and blood glucose. Participants also filled a questionnaire. Glomerular filtration rate was estimated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. All participants were asked about their annoyance by different noise sources at home, and those living in the city of Plovdiv (n = 132) were assigned noise map Lden and Lnight exposure. The effects of noise exposure on systolic blood pressure (SBP), diastolic blood pressure (DBP), and estimated glomerular filtration rate (eGFR) were explored using mixed linear models.
Traffic noise annoyance was associated with higher SBP in the total sample. The other noise indicators were associated with non-significant elevation in SBP and reduction in eGFR. The effect of Lden was more pronounced in patients with prior ischemic heart disease/stroke, diabetes, obesity, not taking Ca-channel blockers, and using solid fuel/gas at home. Lnight had stronger effect among those not taking statins, sleeping in a bedroom with noisy façade, having a living room with quiet façade, and spending more time at home. The increase in Lden was associated with a significant decrease in eGFR among men, patients with ischemic heart disease/stroke, and those exposed to lower air pollution. Regarding Lnight, there was significant effect modification by gender, diabetes, obesity, and time spent at home. In some subgroups, the effect of RTN was statistically significant.
Given that generic risk factors for poor progression of cardiovascular diseases cannot be controlled sufficiently at individual level, environmental interventions to reduce residential noise exposure might result in some improvement in the management of blood pressure and kidney function in patients with CVD.
道路交通噪声（RTN）是心血管疾病（CVD）和高血压的一个风险因素；然而，很少有研究探讨其与既往有CVD患者的血压（BP）和肾功能之间的关联。
本研究旨在探讨居住环境中暴露于RTN对普罗夫迪夫省CVD患者血压和肾功能的影响。
我们纳入了来自普罗夫迪夫市三家三级医院的217例缺血性心脏病和/或高血压患者（2016年3月至5月）。回顾了患者的病史、医疗记录和用药方案，并进行了血压和人体测量。对血样进行肌酐、总胆固醇和血糖分析。参与者还填写了一份问卷。使用慢性肾脏病流行病学协作组（CKD-EPI）方程估算肾小球滤过率。询问了所有参与者在家中受到不同噪声源干扰的情况，并为居住在普罗夫迪夫市的参与者（n = 132）分配了噪声地图Lden和Lnight暴露值。使用混合线性模型探讨噪声暴露对收缩压（SBP）、舒张压（DBP）和估算肾小球滤过率（eGFR）的影响。
在总样本中，交通噪声烦恼与较高的SBP相关。其他噪声指标与SBP的非显著性升高和eGFR的降低相关。Lden的影响在既往有缺血性心脏病/中风、糖尿病、肥胖、未服用钙通道阻滞剂以及在家中使用固体燃料/燃气的患者中更为明显。Lnight在未服用他汀类药物、在临街嘈杂的卧室睡觉、客厅临街安静以及在家中停留时间较长的人群中影响更强。Lden的增加与男性、缺血性心脏病/中风患者以及暴露于较低空气污染环境中的患者的eGFR显著降低相关。关于Lnight，性别、糖尿病、肥胖和在家中停留时间对其有显著的效应修正作用。在一些亚组中，RTN的影响具有统计学意义。
鉴于心血管疾病进展不良的一般风险因素在个体层面无法得到充分控制，减少居住噪声暴露的环境干预措施可能会在一定程度上改善CVD患者的血压管理和肾功能。
