Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, And Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, And School of Basic Medicine, Peking Union Medical College, Beijing, China.
Environ Res. 2021 Aug;199:111356. doi: 10.1016/j.envres.2021.111356. Epub 2021 May 26.
Evidence regarding the effects of ambient air pollution on new stage 1 hypertension defined by the 2017 ACC/AHA Hypertension Guideline remains sparse.
To investigate the association of long-term exposure to ambient PM with stage 1 hypertension and to explore the mediating and modifying effects of PM on cardiovascular disease (CVD).
A total of 32,135 participants aged 18-80 years were recruited in 2017. The three-year (2014-2016) average PM concentrations were assessed by a spatial statistical model. Blood pressure (BP) was divided into four categories according to the 2017 ACC/AHA Hypertension Guideline: normal BP (SBP<120 mmHg and DBP<80 mmHg), elevated BP (SBP 120-129 mmHg and DBP<80 mmHg), stage 1 hypertension (SBP 130-139 mmHg or DBP 80-89 mmHg), and stage 2 hypertension (SBP≥140 mmHg or DBP≥90 mmHg or taking antihypertensive medications). The associations of PM with BP categories were estimated by two-level generalized linear mixed models. Analyses stratified by age, mediation and interaction analyses of PM and stage 1 hypertension with CVD were performed.
We detected a positive significant association between long-term exposure to PM and stage 1 hypertension. Compared to normal BP, the OR was 1.05 (95% CI: 1.02, 1.08) per 10 μg/m increase in PM. The association was stronger than that of elevated BP but weaker than that of stage 2 hypertension. Stage 1 hypertension only partially mediated the association between PM and CVD, and the mediation proportions ranged from 1.55% to 11.00%. However, it modified the association between PM and CVD, which was greater in participants with stage 1 hypertension (OR: 1.66; 95% CI: 1.43, 1.93) than in participants with normal BP (OR: 1.32; 95% CI: 1.11, 1.57), with P<0.001. In the analysis stratified by age, the above associations were age-specific, and significant associations were only observed in the young and middle-aged (<60 years) groups.
Long-term exposure to ambient PM was significantly associated with stage 1 hypertension. This earlier stage of hypertension may be a trigger BP range for adverse effects of air pollution in the development of hypertension and CVD, especially in young and middle-aged individuals.
有关环境空气污染对 2017 年 ACC/AHA 高血压指南定义的新 1 期高血压影响的证据仍然很少。
研究长期暴露于大气 PM 与 1 期高血压之间的关联，并探讨 PM 对心血管疾病 (CVD) 的中介和调节作用。
2017 年共招募了 32135 名 18-80 岁的参与者。通过空间统计模型评估了为期三年（2014-2016 年）的平均 PM 浓度。根据 2017 年 ACC/AHA 高血压指南，将血压 (BP) 分为四类：正常血压 (SBP<120mmHg 和 DBP<80mmHg)、血压升高 (SBP 120-129mmHg 和 DBP<80mmHg)、1 期高血压 (SBP 130-139mmHg 或 DBP 80-89mmHg) 和 2 期高血压 (SBP≥140mmHg 或 DBP≥90mmHg 或服用降压药物)。通过两级广义线性混合模型估计 PM 与 BP 类别的关联。对年龄、PM 和 1 期高血压与 CVD 的中介和交互分析进行分层分析。
我们发现，长期暴露于 PM 与 1 期高血压呈正显著相关。与正常血压相比，PM 每增加 10μg/m，OR 为 1.05(95%CI：1.02，1.08)。这种关联强于血压升高，但弱于 2 期高血压。1 期高血压仅部分介导了 PM 与 CVD 之间的关联，中介比例范围为 1.55%-11.00%。然而，它改变了 PM 与 CVD 之间的关联，在 1 期高血压患者中，这种关联更大（OR：1.66；95%CI：1.43，1.93），而在正常血压患者中，这种关联较小（OR：1.32；95%CI：1.11，1.57），P<0.001。在按年龄分层的分析中，上述关联具有年龄特异性，仅在年轻和中年（<60 岁）人群中观察到显著关联。
长期暴露于大气 PM 与 1 期高血压显著相关。这种高血压的早期阶段可能是空气污染对高血压和 CVD 发展产生不良影响的触发血压范围，尤其是在年轻和中年人群中。
