Air pollution and hypertension: Mechanistic and epidemiological insights

Air pollution is an important environmental risk factor and, according to the Global Burden of Disease Study, a leading contributor to global morbidity and mortality. Hypertension, a major risk factor for cardiovascular diseases, has been increasingly associated with exposure to various air pollutants. This review aims to highlight key mechanistic and epidemiological findings underlying the relationship between air pollution and hypertension. On a mechanistic level, air pollution contributes to oxidative stress, systemic inflammation, endothelial dysfunction, and activation of the sympathetic nervous system, leading to impaired vascular function and elevated blood pressure. Epidemiological findings consistently demonstrate that both short- and long-term exposure to solid and gaseous pollutants are associated with increased blood pressure and a higher risk of hypertension. These findings are confirmed by meta-analyses across diverse populations, with evidence suggesting greater susceptibility among vulnerable groups, including the elderly and those with pre-existing cardiovascular conditions. Despite emerging evidence, important knowledge gaps remain regarding precise exposure assessment, the impact of specific air pollutants, and the synergy between air pollution and other environmental stressors. Targeting these gaps in future is necessary for effective development of public health interventions and policy measures to reduce the adverse health effects of air pollution on blood pressure regulation and hypertension risk.