Arterial Blood Pressure and Long-Term Exposure to Traffic-Related Air Pollution: An Analysis in the European Study of Cohorts for Air Pollution Effects (ESCAPE)

Abstract

Background: Long-term exposure to air pollution has been hypothesized to elevate arterial blood pressure (BP). The existing evidence is scarce and country specific.Objectives: We investigated the cross-sectional association of long-term traffic-related air pollution with BP and prevalent hypertension in European populations.Methods: We analyzed 15 population-based cohorts, participating in the European Study of Cohorts for Air Pollution Effects (ESCAPE). We modeled residential exposure to particulate matter and nitrogen oxides with land use regression using a uniform protocol. We assessed traffic exposure with traffic indicator variables. We analyzed systolic and diastolic BP in participants medicated and nonmedicated with BP-lowering medication (BPLM) separately, adjusting for personal and area-level risk factors and environmental noise. Prevalent hypertension was defined as ≥ 140 mmHg systolic BP, or ≥ 90 mmHg diastolic BP, or intake of BPLM. We combined cohort-specific results using random-effects meta-analysis.Results: In the main meta-analysis of 113,926 participants, traffic load on major roads within 100 m of the residence was associated with increased systolic and diastolic BP in nonmedicated participants [0.35 mmHg (95% CI: 0.02, 0.68) and 0.22 mmHg (95% CI: 0.04, 0.40) per 4,000,000 vehicles × m/day, respectively]. The estimated odds ratio (OR) for prevalent hypertension was 1.05 (95% CI: 0.99, 1.11) per 4,000,000 vehicles × m/day. Modeled air pollutants and BP were not clearly associated.Conclusions: In this first comprehensive meta-analysis of European population-based cohorts, we observed a weak positive association of high residential traffic exposure with BP in nonmedicated participants, and an elevated OR for prevalent hypertension. The relationship of modeled air pollutants with BP was inconsistent.Citation: Fuks KB, Weinmayr G, Foraster M, Dratva J, Hampel R, Houthuijs D, Oftedal B, Oudin A, Panasevich S, Penell J, Sommar JN, Sørensen M, Tittanen P, Wolf K, Xun WW, Aguilera I, Basagaña X, Beelen R, Bots ML, Brunekreef B, Bueno-de-Mesquita HB, Caracciolo B, Cirach M, de Faire U, de Nazelle A, Eeftens M, Elosua R, Erbel R, Forsberg B, Fratiglioni L, Gaspoz JM, Hilding A, Jula A, Korek M, Krämer U, Künzli N, Lanki T, Leander K, Magnusson PK, Marrugat J, Nieuwenhuijsen MJ, Östenson CG, Pedersen NL, Pershagen G, Phuleria HC, Probst-Hensch NM, Raaschou-Nielsen O, Schaffner E, Schikowski T, Schindler C, Schwarze PE, Søgaard AJ, Sugiri D, Swart WJ, Tsai MY, Turunen AW, Vineis P, Peters A, Hoffmann B. 2014. Arterial blood pressure and long-term exposure to traffic-related air pollution: an analysis in the European Study of Cohorts for Air Pollution Effects (ESCAPE). Environ Health Perspect 122:896–905; http://dx.doi.org/10.1289/ehp.1307725

Association between Perceived Built Environment and Prevalent Hypertension among South African Adults

“…Likewise, perceived greater safety in the neighborhood was associated with a lower probability of hypertension [44]. In another metaanalysis, traffic volume on major roads within 100 m of the residence was associated with increased systolic and diastolic blood pressure [49]. In our current study, we did not find a significant relationship between physical activity and hypertension.…”

Road traffic noise, blood pressure and heart rate: Pooled analyses of harmonized data from 88,336 participants

“…(Fuks et al, 2014)). It is therefore unclear to what extent the conclusions of our study can be generalized to regions with higher levels of noise and air pollution.…”

Long-term particulate matter exposure: Attributing health effects to individual PM components

“…Two Canadian papers found the opposite for both cardiovascular and COPD endpoints (Gan et al, 2010;Gan et al, 2013); in their joint models, BC dominated PM 2.5 . Several of the European papers reported significant associations with PM 2.5 , but not with PM abs in single-pollutant models Cesaroni et al, 2014;Fuks et al, 2014;MacIntyre et al, 2014;Pedersen et al, 2013;Raascshou-Nielsen et al, 2013); hence, within Europe the ESCAPE study appears to suggest that PM 2.5 mass is a better indicator of pollution of concern than PM abs . The Canadian studies suggest the opposite.…”

“…The ESCAPE studies considered a wide range of health endpoints, including mortality by several cause categories Dimakopoulou et al, 2014;Wang et al, 2014), several morbidity measures MacIntyre et al, 2014;Raaschou-Nielsen et al, 2013;Schikowski et al, 2014;Stafoffia et al, 2014;Fuertes et al, 2014), physiological measures (Fuks et al, 2014;Gehring et al, 2013;Gruzieva et al, 2014), and reproductive measures (Pederen et al, 2013). The results from these studies varied according to the endpoint studied, with cardiovascular endpoints generally showing a significant association with PM 2.5 mass, but not with PM 2.5 absorbance .…”