Association of Long-Term Exposure to Traffic-Related Air Pollution with Blood Pressure and Hypertension in an Adult Population—Based Cohort in Spain (the REGICOR Study)
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Citation: Foraster M, Basagaña X, Aguilera I, Rivera M, Agis D, Bouso L, Deltell A, Marrugat J, Ramos R, Sunyer J, Vila J, Elosua R, Künzli N. Association of Long-Term Exposure to Traffic-Related Air Pollution with Blood Pressure and Hypertension in an Adult Population—Based Cohort in Spain (the REGICOR Study). Environ Health Perspect; http://dx.doi.org/10.1289/ehp.1306497.
Received: 7 January 2013
Accepted: 11 February 2014
Advance Publication: 14 February 2014
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Background: Long-term exposure to traffic-related air pollution may increase blood pressure (BP) and induce hypertension; however evidence is limited and this association may be confounded by traffic noise, and biased due to inappropriate control for BP-lowering medications.
Objectives: We evaluated the association between long-term traffic-related air pollution, BP and prevalent hypertension, adjusting for transportation noise, and assessing different methodologies to control for BP-lowering medications.
Methods: We measured systolic (SBP) and diastolic BP (DBP) at baseline (years 2003-2005) in 3700 participants, aged 35-83, from a population-based cohort in Spain. We estimated home outdoor annual average concentrations of nitrogen dioxide (NO2) with a land-use regression model. We used multivariate linear and logistic regression.
Results: A 10-μg/m3 increase in NO2 levels was associated with 1.34 mmHg (95% CI: 0.14, 2.55) higher SBP in non-medicated individuals, after adjusting for transportation noise. Results were similar in the entire population after adjusting for medication, as commonly done, but weaker when other methods were used to account for medication use. For example, when 10 mmHg were added to the measured SBP levels of medicated participants, the association was β = 0.78 (95% CI: -0.43, 2.00). NO2 was not associated with hypertension. Associations of NO2 with SBP and DBP were stronger in participants with cardiovascular disease, and the association with SBP was stronger in those exposed to high traffic density and traffic noise levels ≥ 55dB(A).
Conclusions: We observed a positive association between long-term exposure to NO2 and SBP, after adjustment for transportation noise, which was sensitive to the methodology used to account for medication.
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