Geographic variations in the blood pressure responses to short-term fine particulate matter exposure in China

Results from recent studies on associations between blood pressure (BP) and short-term exposure to fine particulate matter (PM_2.5) have been inconsistent. Most studies have been evaluations of small geographic areas, with no national study in China. This study aimed to examine the acute BP responses to ambient PM_2.5 among the general population of Chinese adults. During 2012-2015, systolic and diastolic BP levels were obtained from a large national representative sample, the China Hypertension Survey database (n = 479,842). Daily PM_2.5 average exposures with a spatial resolution of 0.1° were estimated using a data assimilation that combines satellite measurements, air model simulations, and monitoring values. Overall, a 10-μg/m³ increase in daily PM_2.5 was associated with a 0.035 (95% confidence interval: 0.020, 0.049) mmHg change in systolic BP and 0.001 (-0.008, 0.011) mmHg in diastolic BP after adjustments. Stratified by geographic regions, the systolic and diastolic BP levels varied from -0.050 (-0.109, 0.010) to 0.242 (0.176, 0.307) mmHg, and from -0.026 (-0.053, 0.001) to 0.051 (0.020, 0.082) mmHg, respectively. Statistically significant positive BP-PM_2.5 associations were only found in South and North China for systolic levels and in Southwest China for diastolic levels. We further explored the regional study population characteristics and exposure-response curves, and found that the geographic variations in BP-PM_2.5 associations were probably due to different population compositions or different PM_2.5 exposure levels. Our study provided national-level evidence on the associations between ambient PM_2.5 exposure and elevated BP levels. The magnitude of the estimated associations varied substantially by geographic location in China. CLINICAL TRIAL REGISTRATION: The Clinical trial registration name was Survey on prevalence of hypertension in China; the registration number was ChiCTR-ECS-14004641. http://www.chictr.org.cn/showproj.aspx?proj=4932.