Associations between long-term exposure to air pollution and blood pressure and effect modifications by behavioral factors

Background: Studies on the hypertensive effect of long-term air pollution exposure were inconclusive and showed scarce evidence from rural areas in developing countries. In this context, we examined the associations of air pollution exposure with hypertension and blood pressure, and their effect modifiers in rural Chinese adults. Methods: We studied 39,259 participants from a cohort established in five rural regions of central China. Individual exposures to PM_2.5 and PM₁₀ (particulate matter with an aerodynamic diameter less than or equal to 2.5 μm and 10 μm) and nitrogen dioxide (NO₂) was evaluated using satellite-based spatiotemporal models. Mixed-effect regression models were applied to examine the associations of long-term exposure to air pollution with hypertension and four blood pressure component measurements, including systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and pulse pressure (PP). Several potential effect modifiers related to demographic and behavioral factors were also examined. Results: The results showed that for each 1 μg/m³ increase in PM_2.5, PM₁₀ and NO₂, the adjusted odds ratio of hypertension was 1.029 (95%CI: 1.001,1.057), 1.015 (95%CI: 1.001, 1.029) and 1.069 (95%CI: 1.038, 1.100), respectively. These three air pollutants were also associated with increased SBP (except for PM₁₀), DBP and MAP. The hypertensive effects of air pollution were more pronounced among males, smokers, drinkers, individuals with a high-fat diet, and those with high-level physical activity. Conclusion: Long-term exposure to PM_2.5, PM₁₀ and NO₂ was associated with increased blood pressure and hypertension in rural Chinese adults, and the associations were modified by several behavioral factors.