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Clearing the air to treat hypertension

Journal of Human Hypertension volume 34, pages 759–763 (2020)Cite this article

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High blood pressure (BP) impacts over a billion people and is the leading risk factor for global morbidity and mortality [1,2,3]. More than half of all cardiovascular events are due to hypertension. In the United States alone, 103 million (45.6%) adults have high BP (≥130/80 mm Hg)3. However, less than half of Americans with hypertension are currently treated to goal [4]. Widespread health disparities persist such that control rates are even worse in minority and vulnerable communities. Across developing and lower-income nations, a dismal percentage (15–20%) achieve adequate BP control [5]. Given these sobering statistics, large-scale initiatives are now more than ever needed to combat hypertension [6]. Our aim is to show that practical strategies that reduce air pollution exposures may be a novel tactic to help in the global battle against hypertension.

Numerous studies have demonstrated that exposure to higher levels of ambient air pollutants can raise BP [8,9,10]. On average, a 10 µg/m3 increase in PM2.5 during the previous day increases systolic and diastolic BP by 0.5–1.0 mm Hg [10]. However, there is a wide range of responses with some individuals having much larger elevations (5–10 mm Hg) [11]. The inhalation of extreme concentrations of PM2.5 for only 2-h is capable of acutely raising BP. On the other hand, living in locations facing higher ambient levels increases the risk for developing overt hypertension over a few years. Determinants of susceptibility include sex, age, baseline BP, anti-hypertensive medication use, and certain co-morbidities (e.g., obesity) [9,10,11]. In addition, the BP responses can be modified by particulate composition and co-pollutants (ozone) as well as other environmental factors (e.g., temperature, barometric pressure) [12, 13]. The acute exposure-response relationship appears to be largely monotonic and independent of chronic concentrations of ambient PM2.5 [9, 10]. This means that people living in heavily-polluted locations (e.g., Asia) are not immune to the acute BP-raising effects provoked by day-to-day increases in PM2.5. Their absolute BP responses are in fact larger compared to individuals residing in less-polluted regions because ambient concentrations and their variations are generally threefold to tenfold higher (50–100 ± 10–50 versus 5–25 ± 2–10 µg/m3) [14].

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Fig. 1: Circular relationships among fine particulate matter air pollution, high blood pressure, and cardiovascular risk.
Fig. 2: Pathways and end-organ mechanisms whereby fine particulate matter air pollution exposures can increase blood pressure.
Fig. 3: Temporal relationships between fine particulate matter air pollution exposures and blood pressure changes.

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Authors and Affiliations

  1. Division of Cardiology and the Center for the Prevention of Cardiovascular Disease, New York University Grossman School of Medicine, New York, NY, USA

    Jonathan D. Newman

  2. Division of Cardiovascular Medicine, Case Western Reserve University, Cleveland, OH, USA

    Sanjay Rajagopalan

  3. Department of Emergency Medicine, Wayne State University, Detroit, MI, USA

    Phillip Levy

  4. Division of Cardiovascular Medicine, University of Michigan, New York, NY, USA

    Robert D. Brook

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  1. Jonathan D. Newman
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Correspondence to Robert D. Brook.

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This work was partially supported by grants from the National Institutes of Health: R01-ES019616 (Brook and Rajagopalan) and 2R01-NR014484 (Brook). The authors declare that they have no conflict of interest.

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Newman, J.D., Rajagopalan, S., Levy, P. et al. Clearing the air to treat hypertension. J Hum Hypertens 34, 759–763 (2020). https://doi.org/10.1038/s41371-020-0358-9

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