Associations of long-term exposure to ambient ozone with hypertension, blood pressure, and the mediation effects of body mass index: A national cross-sectional study of middle-aged and older adults in China

Background: The associations between long-term exposure to ozone (O3) and respiratory diseases are well established. However, its association with cardiovascular disease (CVD) remains controversial. In this study, we examined the associations between O-3 and the prevalence of hypertension and blood pressure, and the mediation effects of body mass index (BMI) in Chinese middle-aged and older adults. Methods: In this national cross-sectional study, we estimated the O-3 exposure of 12,028 middle-aged and older adults from 126 county-level cities in China, using satellite-based spatiotemporal models. Generalized linear mixed models were used to evaluate the associations of long-term exposure to O-3 with hypertension and blood pressure, including systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and pulse pressure (PP). Mediation effect models were applied to examine the mediation effects of BMI among O-3-induced hypertension and elevated blood pressure. Results: Each 10 mu g/m3 increase in O-3 concentration was significantly associated with an increase of 13.7% (95% confidence interval (CI): 4.8%, 23.3%) in the prevalence of hypertension, an increase of 1.128 mmHg (95% CI: 0.248, 2.005), 0.679 mmHg (95% CI: 0.059, 1.298), 0.820 mmHg (95%CI: 0.245, 1.358) in SBP, DBP, and MAP, respectively. Mediation effect models showed that BMI played 40.08%, 37.25%, 39.95%, and 33.51% mediation roles in the effects of long-term exposure to O-3 on hypertension, SBP, DBP, and MAP, respectively. Conclusions: Long-term exposure to O-3 can increase the prevalence of hypertension and blood pressure levels of middle-aged and older adults, and an increase of BMI would be an important modification effect for O-3-induced hypertension and blood pressure increase.

Automated summary

This study found that long-term exposure to ozone may increase the prevalence of hypertension and blood pressure levels in middle-aged and older adults, and an increase in BMI could be an important modifying factor for ozone-induced hypertension and blood pressure increase.