Global association between ambient air pollution and blood pressure: A systematic review and meta-analysis

Bo Yi Yang, Zhengmin Qian, Steven W. Howard, Michael G. Vaughn, Shu Jun Fan, Kang Kang Liu, Guang Hui Dong

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313 Citations (Scopus)


Although numerous studies have investigated the association of ambient air pollution with hypertension and blood pressure (BP), the results were inconsistent. We performed a comprehensive systematic review and meta-analysis of these studies. Seven international and Chinese databases were searched for studies examining the associations of particulate (diameter<2.5 μm (PM2.5), 2.5–10 μm (PM2.5-10) or >10 μm (PM10)) and gaseous (sulfur dioxide (SO2), nitrogen dioxide (NO2), nitrogen oxides (NOx), ozone (O3), carbon monoxide (CO)) air pollutants with hypertension or BP. Odds ratios (OR), regression coefficients (β) and their 95% confidence intervals were calculated to evaluate the strength of the associations. Subgroup analysis, sensitivity analysis, and meta-regression analysis were also conducted. The overall meta-analysis showed significant associations of long-term exposures to PM2.5 with hypertension (OR = 1.05), and of PM10, PM2.5, and NO2 with DBP (β values: 0.47–0.86 mmHg). In addition, short-term exposures to four (PM10, PM2.5, SO2, NO2), two (PM2.5 and SO2), and four air pollutants (PM10, PM2.5, SO2, and NO2), were significantly associated with hypertension (ORs: 1.05–1.10), SBP (β values: 0.53–0.75 mmHg) and DBP (β values: 0.15–0.64 mmHg), respectively. Stratified analyses showed a generally stronger relationship among studies of men, Asians, North Americans, and areas with higher air pollutant levels. In conclusion, our study indicates a positive association between ambient air pollution and increased BP and hypertension. Geographical and socio-demographic factors may modify the pro-hypertensive effects of air pollutants. Meta-analysis shows significant associations between ambient air pollution and hypertension.

Original languageEnglish
Pages (from-to)576-588
Number of pages13
JournalEnvironmental Pollution
Publication statusPublished - 2018 Apr

Bibliographical note

Funding Information:
This work was supported by grants from the National Key Research and Development Program of China (grant number 2016YFC0207000 ); the Fundamental Research Funds for the Central Universities (No. 16ykzd02 ; 17ykpy16 ); and the National Natural Science Foundation of China (No. 91543208 ; No. 81703179 ).

Publisher Copyright:
© 2018 Elsevier Ltd

All Science Journal Classification (ASJC) codes

  • Toxicology
  • Pollution
  • Health, Toxicology and Mutagenesis


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