Early exposure to air pollutants linked to high blood pressure in children, adolescents

Reviewed by Emily Henderson, B.Sc.May 4 2021

A meta-analysis of 14 air pollution studies from around the world found that exposure to high levels of air pollutants during childhood increases the likelihood of high blood pressure in children and adolescents, and their risk for high blood pressure as adults. The study is published in a special issue on air pollution in the Journal of the American Heart Association, an open access journal of the American Heart Association.

Other studies look at: the effects of diesel exhaust on the muscle sympathetic nerve; the impact of pollutants on high blood pressure; rates of hospital readmission for heart failure among those exposed to high levels of ambient air pollution; and risk of stroke and heart attack after long-term exposure to high levels of particulate matter. The studies include health outcomes of people who were exposed to pollutants in the United States, China and Europe.

High blood pressure during childhood and adolescence is a risk factor for hypertension and heart disease in adulthood. Studies on air pollution and blood pressure in adolescents and children, however, have produced inconsistent conclusions. This systematic review and meta-analysis pooled information from 14 studies focused on the association between air pollution and blood pressure in youth. The large analysis included data for more than 350,000 children and adolescents (mean ages 5.4 to 12.7 years of age).

Our analysis is the first to closely examine previous research to assess both the quality and magnitude of the associations between air pollution and blood pressure values among children and adolescents. The findings provide evidence of a positive association between short- and long-term exposure to certain environmental air pollutants and blood pressure in children and adolescents."

Yao Lu, M.D., Ph.D., Study Lead Author and Professor, Clinical Research Center, Third Xiangya Hospital at Central South University in Changsha, China, and Professor,  Department of Life Science and Medicine, King's College London

The analysis included 14 studies published through September 6, 2020, exploring the impact of long-term exposure (?30 days) and/or short-term exposure (<30 days) of ambient air pollution on blood pressure levels of adolescents and/or children in China and/or countries in Europe.

The studies were divided into groups based upon length of exposure to air pollution and by composition of air pollutants, specifically nitrogen dioxide and particulate matter with diameter ?10 μm or ?2.5 μm. (The majority of research linking heart disease with particulate matter focuses on particle matter mass, which is categorized by aerodynamic diameter - μm or PM.) Fine particles are defined as PM2.5 and larger; coarse particles are defined at PM10; and the concentrations of particulate matter are typically measured in their mass per volume of air (μg/m3).

The meta-analysis concluded:

• Short-term exposure to PM10 was significantly associated with elevated systolic blood pressure in youth (the top number on a blood pressure reading).
• Periods of long-term exposure to PM2.5, PM10 and nitrogen dioxide were also associated with elevated systolic blood pressure levels.
• Higher diastolic blood pressure levels (the bottom number on a blood pressure reading) were associated with long-term exposure to PM2.5 and PM10.

"To reduce the impact of environmental pollution on blood pressure in children and adolescents, efforts should be made to reduce their exposure to environmental pollutants," said Lu. "Additionally, it is also very important to routinely measure blood pressure in children and adolescents, which can help us identify individuals with elevated blood pressure early."

The results of the analysis are limited to the studies included, and they did not include data on possible interactions between different pollutants, therefore, the results are not generalizable to all populations. Additionally, the analysis included the most common and more widely studied pollutants vs. air pollutants confirmed to have heart health impact, of which there are fewer studies.