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 (PM2.5) 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 PM2.5 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 PM2.5 average exposures with a spatial resolution of 0.1 degrees were estimated using a data assimilation that combines satellite measurements, air model simulations, and monitoring values. Overall, a 10-mu g/m(3) increase in daily PM2.5 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-PM2.5 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-PM2.5 associations were probably due to different population compositions or different PM2.5 exposure levels. Our study provided national-level evidence on the associations between ambient PM2.5 exposure and elevated BP levels. The magnitude of the estimated associations varied substantially by geographic location in China. (C) 2020 Elsevier B.V. All rights reserved.