Long-Term Exposure to NO2 and Ozone and Hypertension Incidence in the Black Women's Health Study

Am J Hypertens. 2017 Apr 1;30(4):367-372. doi: 10.1093/ajh/hpw168.


Background: Evidence shows that exposure to air pollutants can increase blood pressure in the short and long term. Some studies show higher levels of hypertension prevalence in areas of high pollution. Few data exist on the association of air pollution with hypertension incidence. The purpose of the present study was to prospectively assess the associations of the traffic-related nitrogen dioxide (NO2) and of ozone with the incidence of hypertension in the Black Women's Health Study (BWHS), a large cohort study of African American women.

Methods: We used Cox proportional hazards models to calculate hazard ratios (HRs) and 95% confidence intervals (CI) for hypertension associated with exposure to NO2 and ozone among 33,771 BWHS participants. NO2 and ozone levels at participant residential locations were estimated with validated models.

Results: From 1995 to 2011, 9,570 incident cases of hypertension occurred in a total of 348,154 person-years (median follow-up time, 11 years). The multivariable HRs per interquartile range of NO2 (9.7 ppb) and ozone (6.7 ppb) were 0.92 (95% CI = 0.86, 0.98) and 1.09 (95% CI = 1.00, 1.18).

Conclusions: In this large cohort of African American women, higher ozone levels were associated with an increase in hypertension incidence. Higher NO2 levels were not associated with greater hypertension incidence; indeed, incidence was lower at higher NO2 levels.

Keywords: African American; air pollution; blood pressure; hypertension; hypertension incidence; women..

MeSH terms

  • Adult
  • African Americans / statistics & numerical data*
  • Aged
  • Air Pollution / statistics & numerical data*
  • Environmental Exposure / statistics & numerical data*
  • Female
  • Follow-Up Studies
  • Humans
  • Hypertension / epidemiology*
  • Incidence
  • Middle Aged
  • Multivariate Analysis
  • Nitrogen Dioxide*
  • Ozone*
  • Proportional Hazards Models
  • Time Factors
  • Young Adult


  • Ozone
  • Nitrogen Dioxide