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Long-term exposure to high particulate matter pollution and incident hypertension: a 12-year cohort study in northern China


Numerous cohort studies have reported the association of long-term exposure to particulate matter <10 μm in diameter (PM10) and hypertension in American and European countries. However, these results have been inconsistent and subject to various confounding factors. The study aimed to explore the effect of long-term exposure to high-level concentrations of PM10 on incident hypertension in a large-scale cohort from northern China. A retrospective cohort study of 39,054 participants aged between 23 and 98 years old from four cities in northern China was followed from 1998 to 2009. Excluding those with hypertension, 37,386 non-hypertensive participants (overall population) were followed for self-reported hypertension. The individuals’ exposure to PM10 was the mean concentration during the follow-up period, according to the data of local environmental monitoring centers. Hazard ratios (HRs) were calculated by Cox proportional hazards models. The adjusted potential confounding factors included sociodemographic information, lifestyle, and diet. There were 2619 (7.0%) incident cases of hypertension among the overall population. In multivariable models, the HR (95% CI) of incident hypertension was 1.537 (1.515, 1.560) for each 10 μg/m3 increase in PM10. Stratified analyses showed individuals (age <65) were prone to developing hypertension. Moreover, the effects of PM10 increased and produced an HR (95% CI) of 1.555 (1.527, 1.584) for the healthy population in the sensitivity analysis. We found that the association between long-term exposure to PM10 air pollution and incident hypertension was significantly positive.

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Fig. 1: Study areas and the locations of air pollution monitors in four cities in China.
Fig. 2: Detailed information on study population recruitment.
Fig. 3: Annual average concentrations of PM10 (μg/m3) in the 15 districts of four cities in northern China.

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  1. Forouzanfar MH, Alexander L, Anderson HR, Bachman VF, Biryukov S, Brauer M, et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;386:2287–323.

    Article  Google Scholar 

  2. GBD 2015 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388:1659–1724.

  3. Chen H, Burnett RT, Kwong JC, Villeneuve PJ, Goldberg MS, Brook RD, et al. Spatial association between ambient fine particulate matter and incident hypertension. Circulation. 2014;129:562–9.

    Article  CAS  Google Scholar 

  4. Cai Y, Zhang B, Ke W, Feng B, Lin H, Xiao J, et al. Associations of short-term and long-term exposure to ambient air pollutants with hypertension: a systematic review and meta-analysis. Hypertension. 2016;68:62–70.

    Article  CAS  Google Scholar 

  5. Chen SY, Wu CF, Lee JH, Hoffmann B, Peters A, Brunekreef B, et al. Associations between long-term air pollutant exposures and blood pressure in elderly residents of Taipei city: a cross-sectional study. Environ Health Perspect. 2015;123:779–84.

    Article  CAS  Google Scholar 

  6. Dong GH, Qian ZM, Trevathan E, Zeng XW, Vaughn MG, Wang J, et al. Air pollution associated hypertension and increased blood pressure may be reduced by breastfeeding in Chinese children: the Seven Northeastern Cities Chinese Children’s Study. Int J Cardiol. 2014;176:956–61.

    Article  Google Scholar 

  7. Dong GH, Qian ZM, Xaverius PK, Trevathan E, Maalouf S, Parker J, et al. Association between long-term air pollution and increased blood pressure and hypertension in China. Hypertension. 2013;61:578–84.

    Article  CAS  Google Scholar 

  8. Franklin BA, Brook R, Arden Pope C III. Air pollution and cardiovascular disease. Curr Probl Cardiol. 2015;40:207–38.

    Article  Google Scholar 

  9. Heinrich J, Thiering E, Rzehak P, Kramer U, Hochadel M, Rauchfuss KM, et al. Long-term exposure to NO2 and PM10 and all-cause and cause-specific mortality in a prospective cohort of women. Occup Environ Med. 2013;70:179–86.

    Article  CAS  Google Scholar 

  10. Pope CA III, Burnett RT, Thurston GD, Thun MJ, Calle EE, Krewski D, et al. Cardiovascular mortality and long-term exposure to particulate air pollution: epidemiological evidence of general pathophysiological pathways of disease. Circulation. 2004;109:71–7.

    Article  Google Scholar 

  11. Yang BY, Qian Z, Howard SW, Vaughn MG, Fan SJ, Liu KK, et al. Global association between ambient air pollution and blood pressure: A systematic review and meta-analysis. Environ Pollut. 2018;235:576–88.

    Article  CAS  Google Scholar 

  12. Zeng XW, Qian ZM, Vaughn MG, Nelson EJ, Dharmage SC, Bowatte G, et al. Positive association between short-term ambient air pollution exposure and children blood pressure in China-Result from the Seven Northeast Cities (SNEC) study. Environ Pollut. 2017;224:698–705.

    Article  CAS  Google Scholar 

  13. Zhang LW, Chen X, Xue XD, Sun M, Han B, Li CP, et al. Long-term exposure to high particulate matter pollution and cardiovascular mortality: a 12-year cohort study in four cities in northern China. Environ Int. 2014;62:41–7.

    Article  Google Scholar 

  14. Cao J, Yang C, Li J, Chen R, Chen B, Gu D, et al. Association between long-term exposure to outdoor air pollution and mortality in China: a cohort study. J Hazard Mater. 2011;186:1594–600.

    Article  CAS  Google Scholar 

  15. Bao J, Yang X, Zhao Z, Wang Z, Yu C, Li X. The spatial-temporal characteristics of air pollution in China from 2001–2014. Int J Environ Res Public Health. 2015;12:15875–87.

    Article  CAS  Google Scholar 

  16. Sun J, Zhou T. Health risk assessment of China’s main air pollutants. BMC Public Health. 2017;17:212.

    Article  Google Scholar 

  17. Zhan D, Kwan MP, Zhang W, Wang S, Yu J. Spatiotemporal Variations and Driving Factors of Air Pollution in China. Int J Environ Res Public Health. 2017;14:1538.

    Article  Google Scholar 

  18. Coogan PF, White LF, Yu J, Brook RD, Burnett RT, Marshall JD, et al. Long-term exposure to NO2 and ozone and hypertension incidence in the Black Women’s Health Study. Am J Hypertens. 2017;30:367–72.

    CAS  PubMed  PubMed Central  Google Scholar 

  19. Coogan PF, White LF, Yu J, Burnett RT, Seto E, Brook RD, et al. PM2.5 and diabetes and hypertension incidence in the Black Women’s Health Study. Epidemiology. 2016;27:202–10.

    PubMed  PubMed Central  Google Scholar 

  20. Fuks KB, Weinmayr G, Basagana X, Gruzieva O, Hampel R, Oftedal B, et al. Long-term exposure to ambient air pollution and traffic noise and incident hypertension in seven cohorts of the European study of cohorts for air pollution effects (ESCAPE). Eur Heart J. 2017;38:983–90.

    CAS  PubMed  Google Scholar 

  21. Zhang Z, Laden F, Forman JP, Hart JE. Long-term exposure to particulate matter and self-reported hypertension: a prospective analysis in the Nurses’ Health Study. Environ Health Perspect. 2016;124:1414–20.

    Article  Google Scholar 

  22. Chen X, Zhang LW, Huang JJ, Song FJ, Zhang LP, Qian ZM, et al. Long-term exposure to urban air pollution and lung cancer mortality: A 12-year cohort study in Northern China. Sci Total Environ. 2016;571:855–61.

    Article  CAS  Google Scholar 

  23. Chen X, Wang X, Huang JJ, Zhang LW, Song FJ, Mao HJ, et al. Nonmalignant respiratory mortality and long-term exposure to PM10 and SO2: A 12-year cohort study in northern China. Environ Pollut. 2017;231:761–7.

    Article  CAS  Google Scholar 

  24. Bennett DA, Du H, Clarke R, Guo Y, Yang L, Bian Z, et al. Association of physical activity with risk of major cardiovascular diseases in Chinese men and women. JAMA Cardio.l 2017;2:1349–58.

    Article  Google Scholar 

  25. Bai L, Chen H, Hatzopoulou M, Jerrett M, Kwong JC, Burnett RT, et al. Exposure to ambient ultrafine particles and nitrogen dioxide and incident hypertension and diabetes. Epidemiology. 2018;29:323–32.

    Article  Google Scholar 

  26. Zhang Z, Guo C, Lau AKH, Chan TC, Chuang YC, Lin C, et al. Long-term exposure to fine particulate matter, blood pressure, and incident hypertension in Taiwanese adults. Environ Health Perspect. 2018;126:017008.

    Article  Google Scholar 

  27. Huang K, Yang X, Liang F, Liu F, Li J, Xiao Q, et al. LonG-term Exposure to Fine Particulate Matter and Hypertension Incidence in China. Hypertension. 2019;73:1195–201.

    Article  CAS  Google Scholar 

  28. Coogan PF, White LF, Jerrett M, Brook RD, Su JG, Seto E, et al. Air pollution and incidence of hypertension and diabetes mellitus in black women living in Los Angeles. Circulation. 2012;125:767–72.

    Article  CAS  Google Scholar 

  29. Foraster M, Basagana X, Aguilera I, Rivera M, Agis D, Bouso L, et al. Association of long-term exposure to traffic-related air pollution with blood pressure and hypertension in an adult population-based cohort in Spain (the REGICOR study). Environ Health Perspect. 2014;122:404–11.

    Article  Google Scholar 

  30. Fuks KB, Weinmayr G, Foraster M, Dratva J, Hampel R, Houthuijs D, et al. Arterial blood pressure and long-term exposure to traffic-related air pollution: an analysis in the European Study of Cohorts for Air Pollution Effects (ESCAPE). Environ Health Perspect. 2014;122:896–905.

    Article  Google Scholar 

  31. Sorensen M, Hoffmann B, Hvidberg M, Ketzel M, Jensen SS, Andersen ZJ, et al. Long-term exposure to traffic-related air pollution associated with blood pressure and self-reported hypertension in a Danish cohort. Environ Health Perspect. 2012;120:418–24.

    Article  Google Scholar 

  32. Li D, Wang JB, Yu ZB, Lin HB, Chen K. Air pollution exposures and blood pressure variation in type-2 diabetes mellitus patients: a retrospective cohort study in China. Ecotoxicol Environ Saf. 2019;171:206–10.

    Article  CAS  Google Scholar 

  33. Brook RD, Rajagopalan S, Pope CA III, Brook JR, Bhatnagar A, Diez-Roux AV, et al. Particulate matter air pollution and cardiovascular disease: an update to the scientific statement from the American Heart Association. Circulation. 2010;121:2331–78.

    Article  CAS  Google Scholar 

  34. Brook RD, Urch B, Dvonch JT, Bard RL, Speck M, Keeler G, et al. Insights into the mechanisms and mediators of the effects of air pollution exposure on blood pressure and vascular function in healthy humans. Hypertension. 2009;54:659–67.

    Article  CAS  Google Scholar 

  35. Cohen L, Curhan GC, Forman JP. Influence of age on the association between lifestyle factors and risk of hypertension. J Am Soc Hypertens. 2012;6:284–90.

    Article  Google Scholar 

  36. Yang BY, Guo Y, Bloom MS, Xiao X, Qian ZM, Liu E, et al. Ambient PM1 air pollution, blood pressure, and hypertension: Insights from the 33 Communities Chinese Health Study. Environ Res. 2019;170:252–9.

    Article  CAS  Google Scholar 

  37. Sabapathy A, Saksena S, Flachsbart P. Environmental justice in the context of commuters’ exposure to CO and PM10 in Bangalore, India. J Expo Sci Environ Epidemiol. 2015;25:200–7.

    Article  CAS  PubMed  Google Scholar 

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This work was supported by the National Key R&D Program of China (2017YFC0211600 & 2017YFC0211605), the National Key R&D Program of China (2017YFC0211704), and the Special Environmental Research Fund for Public Welfare from Ministry of Environmental Protection of China (No. 200709048).

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Correspondence to Nai-jun Tang.

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Li, C., Li, Y., Liu, H. et al. Long-term exposure to high particulate matter pollution and incident hypertension: a 12-year cohort study in northern China. J Hum Hypertens 35, 1129–1138 (2021).

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