Cross-Sectional Analysis of the Relationship Between Home Blood Pressure and Indoor Temperature in Winter A Nationwide Smart Wellness Housing Survey in Japan

Mortality due to cardiovascular disease rises sharply in winter. Known as excess winter mortality, this phenomenon is partially explained by cold exposure-induced high blood pressure. Home blood pressure, especially in the morning, is closely associated with cardiovascular disease risk. We conducted the first large nationwide survey on home blood pressure and indoor temperature in 3775 participants (2095 households) who intended to conduct insulation retrofitting and were recruited by construction companies. Home blood pressure was measured twice in the morning and evening for 2 weeks. The relationship between home blood pressure and indoor temperature in winter was analyzed using a multilevel model with 3 levels: repeatedly measured day-level variables (eg, indoor ambient temperature and quality of sleep), nested within individual-level (eg, age and sex), and nested within household level. Cross-sectional analyses involving about 2900 participants (1840 households) showed that systolic blood pressure in the morning had significantly higher sensitivity to changes in indoor temperature (8.2 mm Hg increase/10 degrees C decrease) than that in the evening (6.5 mm Hg increase/10 degrees C decrease) in participants aged 57 years (mean age in this survey). We also found a nonlinear relationship between morning systolic blood pressure and indoor temperature, suggesting that the effect of indoor temperature on blood pressure varied depending on room temperature range. Interaction terms between age/women and indoor temperature were significant, indicating that systolic blood pressure in older residents and women was vulnerable to indoor temperature change. We expect that these results will be useful in determining optimum home temperature recommendations for men and women of each age group.