Association between long-term air pollutant exposure and blood pressure and hypertension: A stratified analysis based...

Air pollution and vitamin D deficiency may interact to influence blood pressure (BP), but this relationship has not been thoroughly investigated. We examined the associations between air pollutant exposure and BP and hypertension stratified by vitamin D status in Korean adults. A total of 20,732 adults (mean age 60.30 years), who underwent health screenings between 2015 and 2019, were included. Annual mean concentrations of PM_2.5, PM₁₀, SO₂, NO₂, and CO were assessed; vitamin D deficiency was defined as serum 25(OH)D below 20 ng/mL. Associations between air pollutants and BP and hypertension were analyzed using multivariable regression models stratified by vitamin D deficiency status. Of the participants, 55.91% had hypertension, and 42.20% had vitamin D deficiency. After full covariate adjustment, interquartile range-scaled exposure to PM_2.5 (β = 0.326, 95% CI: 0.055, 0.597)/β = 0.535, 95% CI: 0.351, 0.718), PM₁₀ (β = 0.578, 95% CI: 0.237, 0.918/β = 1.270, 95% CI: 1.040, 1.500), and SO₂ (β = 0.374, 95% CI: 0.049, 0.698/β = 1.034, 95% CI: 0.814, 1.253) were linked to increases in systolic blood pressure (SBP) and diastolic blood pressure (DBP). Logistic regression analyses demonstrated that PM₁₀ (OR = 1.073, 95% CI: 1.030, 1.118) and SO₂ (OR = 1.057, 95% CI: 1.018, 1.099) were associated with an increase in the prevalence of hypertension. In stratified analyses, stronger associations of particulate matter and SO₂ with BP and hypertension were observed among participants with vitamin D deficiency. These findings indicate that long-term exposure to particulate matter and gaseous pollutants may contribute to an elevation in BP, particularly among vitamin D-deficient individuals, with attenuation in multi-pollutant models.