Is Prehypertension More Strongly Associated With Long-Term Ambient Air Pollution Exposure Than Hypertension? Findings From the 33 Communities Chinese Health Study

Environ Pollut. 2017 Oct;229:696-704. doi: 10.1016/j.envpol.2017.07.016. Epub 2017 Jul 13.


Numerous studies have evaluated the effects of long-term exposure to ambient air pollution on hypertension. However, little information exists regarding its effects on prehypertension, a very common, but understudied cardiovascular indicator. We evaluated data from 24,845 adults (ages 18-74 years) living in three Northeastern Chinese cities in 2009. Blood pressure (BP) was measured by trained observers using a standardized mercuric-column sphygmomanometer. Three-year (from 2006 to 2008) average concentrations of particles with an aerodynamic diameter ≤10 μm (PM10), sulfur dioxide (SO2), nitrogen dioxides (NO2), and ozone (O3) were calculated using data from monitoring stations. Effects were analyzed using generalized additive models and two-level regression analyses, controlling for covariates. We found positive associations of all pollutants with prehypertension (e.g. odds ratio (OR) was 1.17 (95% confidence interval (CI), 1.09-1.25) per interquartile range (IQR) of PM10) in a fully adjusted model, as compared to normotensive participants. These associations were stronger than associations with hypertension (e.g. OR was 1.03 (95% CI, 1.00, 1.07) per IQR of PM10). We have also found positive associations of all studied pollutants with systolic and diastolic BP: e.g., associations with PM10 per IQR were 1.24 mmHg (95% CI, 1.03-1.45) for systolic BP and 0.47 mmHg (95% CI, 0.33-0.61) for diastolic BP. Further, we observed that associations with BP were stronger in women and in older participants (systolic BP only). In conclusion, long-term exposure to ambient air pollution was more strongly associated with prehypertension than with hypertension, especially among females and the elderly. Thus, interventions to reduce air pollution are of great significance for preventing future cardiovascular events, particularly among individuals with prehypertension.

Keywords: Air pollution; Blood pressure; Chinese; Prehypertension.

MeSH terms

  • Adult
  • Aged
  • Air Pollutants / analysis
  • Air Pollution / analysis
  • Air Pollution / statistics & numerical data*
  • Asian Continental Ancestry Group
  • Blood Pressure
  • China / epidemiology
  • Cities
  • Environmental Exposure / statistics & numerical data*
  • Female
  • Humans
  • Hypertension
  • Male
  • Middle Aged
  • Nitrogen Dioxide / analysis
  • Odds Ratio
  • Ozone / analysis
  • Particulate Matter / analysis
  • Prehypertension / epidemiology*
  • Public Health
  • Regression Analysis
  • Sulfur Dioxide / analysis


  • Air Pollutants
  • Particulate Matter
  • Sulfur Dioxide
  • Ozone
  • Nitrogen Dioxide