The Benefits of Intensive Versus Standard Blood Pressure Treatment According to Fine Particulate Matter Air Pollution Exposure: A Post Hoc Analysis of SPRINT
Fine particulate matter
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| Veröffentlicht in: | Hypertension (Dallas, Tex. 1979) Tex. 1979), 2021-03, Vol.77 (3), p.813-822 |
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| container_title | Hypertension (Dallas, Tex. 1979) |
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| creator | Al-Kindi, Sadeer G. Brook, Robert D. Bhatt, Udayan Brauer, Michael Cushman, William C. Hanson, Heidi A. Kostis, John Lash, James P. Paine, Robert Raphael, Kalani L. Rapp, Stephen Tamariz, Leonardo Wright, Jackson T. Rajagopalan, Sanjay |
| description | Fine particulate matter |
| doi_str_mv | 10.1161/HYPERTENSIONAHA.120.15923 |
| format | Article |
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A large body of evidence suggests a link between PM2.5 and elevation in blood pressure (BP), with the latter implicated as a potential mediator of cardiovascular events. We sought to determine if the outcomes of intensive BP lowering (systolic BP <120 mm Hg) on cardiovascular events are modified by PM2.5 exposure in the SPRINT (Systolic BP Intervention Trial). We linked annual PM2.5 exposure estimates derived from an integrated model to subjects participating in SPRINT. We evaluated the effect of intensive BP lowering by PM2.5 exposure on the primary outcome in SPRINT using cox-proportional hazard models. A total of 9286 participants were linked to PM2.5 levels (mean age 68±9 years). Intensive BP-lowering decreased risk of the primary outcome more among patients exposed to higher PM2.5 (Pinteraction=0.047). The estimate for lowering of primary outcome was numerically lower in the highest than in the lower quintiles. The benefits of intensive BP-lowering were larger among patients chronically exposed to PM2.5 levels above US National Ambient Air Quality Standards of 12 µg/m3 (hazard ratio, 0.47 [95% CI, 0.29–0.74]) compared with those living in cleaner locations (hazard ratio, 0.81 [95% CI, 0.68–0.97]), Pinteraction=0.037. This exploratory nonprespecified post hoc analysis of SPRINT suggests that the benefits of intensive BP lowering on the primary outcome was greater in patients exposed to higher PM2.5, suggesting that the magnitude of benefit may depend upon the magnitude of antecedent PM2.5 exposure.</description><identifier>ISSN: 0194-911X</identifier><identifier>ISSN: 1524-4563</identifier><identifier>EISSN: 1524-4563</identifier><identifier>DOI: 10.1161/HYPERTENSIONAHA.120.15923</identifier><identifier>PMID: 33517683</identifier><language>eng</language><publisher>United States: American Heart Association, Inc</publisher><subject>Aged ; Air Pollutants - analysis ; Antihypertensive Agents - therapeutic use ; Cardiovascular Diseases - etiology ; Cardiovascular Diseases - physiopathology ; Cardiovascular Diseases - prevention & control ; Clinical Trials as Topic ; Environmental Exposure - adverse effects ; Female ; Humans ; Hypertension - drug therapy ; Hypertension - etiology ; Hypertension - physiopathology ; Male ; Middle Aged ; Outcome Assessment, Health Care - methods ; Outcome Assessment, Health Care - statistics & numerical data ; Particulate Matter - analysis ; Proportional Hazards Models ; Risk Factors</subject><ispartof>Hypertension (Dallas, Tex. 1979), 2021-03, Vol.77 (3), p.813-822</ispartof><rights>American Heart Association, Inc</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3610-c5ad2b3ee4ef7d37341a0ecf4683820a13b67b17fe2ea32948d306a579cbdd193</cites><orcidid>0000-0001-6669-8163 ; 0000-0001-7162-2972 ; 0000-0002-1122-7695 ; 0000-0002-8521-7262 ; 0000-0002-9103-9343</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,3687,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33517683$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Al-Kindi, Sadeer G.</creatorcontrib><creatorcontrib>Brook, Robert D.</creatorcontrib><creatorcontrib>Bhatt, Udayan</creatorcontrib><creatorcontrib>Brauer, Michael</creatorcontrib><creatorcontrib>Cushman, William C.</creatorcontrib><creatorcontrib>Hanson, Heidi A.</creatorcontrib><creatorcontrib>Kostis, John</creatorcontrib><creatorcontrib>Lash, James P.</creatorcontrib><creatorcontrib>Paine, Robert</creatorcontrib><creatorcontrib>Raphael, Kalani L.</creatorcontrib><creatorcontrib>Rapp, Stephen</creatorcontrib><creatorcontrib>Tamariz, Leonardo</creatorcontrib><creatorcontrib>Wright, Jackson T.</creatorcontrib><creatorcontrib>Rajagopalan, Sanjay</creatorcontrib><creatorcontrib>SPRINT Research Group</creatorcontrib><creatorcontrib>For the SPRINT Research Group</creatorcontrib><title>The Benefits of Intensive Versus Standard Blood Pressure Treatment According to Fine Particulate Matter Air Pollution Exposure: A Post Hoc Analysis of SPRINT</title><title>Hypertension (Dallas, Tex. 1979)</title><addtitle>Hypertension</addtitle><description>Fine particulate matter <2.5 µm (PM2.5) air pollution is implicated in global mortality, especially from cardiovascular causes. A large body of evidence suggests a link between PM2.5 and elevation in blood pressure (BP), with the latter implicated as a potential mediator of cardiovascular events. We sought to determine if the outcomes of intensive BP lowering (systolic BP <120 mm Hg) on cardiovascular events are modified by PM2.5 exposure in the SPRINT (Systolic BP Intervention Trial). We linked annual PM2.5 exposure estimates derived from an integrated model to subjects participating in SPRINT. We evaluated the effect of intensive BP lowering by PM2.5 exposure on the primary outcome in SPRINT using cox-proportional hazard models. A total of 9286 participants were linked to PM2.5 levels (mean age 68±9 years). Intensive BP-lowering decreased risk of the primary outcome more among patients exposed to higher PM2.5 (Pinteraction=0.047). The estimate for lowering of primary outcome was numerically lower in the highest than in the lower quintiles. The benefits of intensive BP-lowering were larger among patients chronically exposed to PM2.5 levels above US National Ambient Air Quality Standards of 12 µg/m3 (hazard ratio, 0.47 [95% CI, 0.29–0.74]) compared with those living in cleaner locations (hazard ratio, 0.81 [95% CI, 0.68–0.97]), Pinteraction=0.037. This exploratory nonprespecified post hoc analysis of SPRINT suggests that the benefits of intensive BP lowering on the primary outcome was greater in patients exposed to higher PM2.5, suggesting that the magnitude of benefit may depend upon the magnitude of antecedent PM2.5 exposure.</description><subject>Aged</subject><subject>Air Pollutants - analysis</subject><subject>Antihypertensive Agents - therapeutic use</subject><subject>Cardiovascular Diseases - etiology</subject><subject>Cardiovascular Diseases - physiopathology</subject><subject>Cardiovascular Diseases - prevention & control</subject><subject>Clinical Trials as Topic</subject><subject>Environmental Exposure - adverse effects</subject><subject>Female</subject><subject>Humans</subject><subject>Hypertension - drug therapy</subject><subject>Hypertension - etiology</subject><subject>Hypertension - physiopathology</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Outcome Assessment, Health Care - methods</subject><subject>Outcome Assessment, Health Care - statistics & numerical data</subject><subject>Particulate Matter - analysis</subject><subject>Proportional Hazards Models</subject><subject>Risk Factors</subject><issn>0194-911X</issn><issn>1524-4563</issn><issn>1524-4563</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkdtuEzEQhlcIREPhFZC542aLT3viAmlbpSRSSaNmQXBlOd7ZxuDYqe1t6cPwrrhNqQD7wtbMP79n_GXZG4KPCCnJu9m35fSimy5W8_NFO2uPCE2JoqHsSTYhBeU5L0r2NJtg0vC8IeTrQfYihO8YE8559Tw7YKwgVVmzSfar2wA6BguDjgG5Ac1tBBv0NaAv4MMY0CpK20vfo2PjXI-WHkIYPaDOg4xbsBG1Sjnfa3uJokOn2gJaSh-1Go2MgD7JGMGjVnu0dMaMUTuLpj937s7lPWpTNEQ0cwq1VprboO_bWC0v5ovuZfZskCbAq4fzMPt8Ou1OZvnZ-cf5SXuWK1YSnKtC9nTNADgMVc8qxonEoAaeRqwploSty2pNqgEoSEYbXvcMl7KoGrXue9Kww-zD3nc3rrfQqzSVl0bsvN5Kfyuc1OLfjNUbcemuRc3roqnrZPD2wcC7qxFCFFsdFBgjLbgxCMprTkpKKEvSZi9V3oXgYXh8hmBxh1f8h1ckvOIeb6p9_Xefj5V_eCYB3wtunEm_Hn6Y8Qa82IA0cSNwWpyWdU4xJZilnadIuv0Gk7u1rw</recordid><startdate>20210303</startdate><enddate>20210303</enddate><creator>Al-Kindi, Sadeer G.</creator><creator>Brook, Robert D.</creator><creator>Bhatt, Udayan</creator><creator>Brauer, Michael</creator><creator>Cushman, William C.</creator><creator>Hanson, Heidi A.</creator><creator>Kostis, John</creator><creator>Lash, James P.</creator><creator>Paine, Robert</creator><creator>Raphael, Kalani L.</creator><creator>Rapp, Stephen</creator><creator>Tamariz, Leonardo</creator><creator>Wright, Jackson T.</creator><creator>Rajagopalan, Sanjay</creator><general>American Heart Association, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-6669-8163</orcidid><orcidid>https://orcid.org/0000-0001-7162-2972</orcidid><orcidid>https://orcid.org/0000-0002-1122-7695</orcidid><orcidid>https://orcid.org/0000-0002-8521-7262</orcidid><orcidid>https://orcid.org/0000-0002-9103-9343</orcidid></search><sort><creationdate>20210303</creationdate><title>The Benefits of Intensive Versus Standard Blood Pressure Treatment According to Fine Particulate Matter Air Pollution Exposure: A Post Hoc Analysis of SPRINT</title><author>Al-Kindi, Sadeer G. ; 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A large body of evidence suggests a link between PM2.5 and elevation in blood pressure (BP), with the latter implicated as a potential mediator of cardiovascular events. We sought to determine if the outcomes of intensive BP lowering (systolic BP <120 mm Hg) on cardiovascular events are modified by PM2.5 exposure in the SPRINT (Systolic BP Intervention Trial). We linked annual PM2.5 exposure estimates derived from an integrated model to subjects participating in SPRINT. We evaluated the effect of intensive BP lowering by PM2.5 exposure on the primary outcome in SPRINT using cox-proportional hazard models. A total of 9286 participants were linked to PM2.5 levels (mean age 68±9 years). Intensive BP-lowering decreased risk of the primary outcome more among patients exposed to higher PM2.5 (Pinteraction=0.047). The estimate for lowering of primary outcome was numerically lower in the highest than in the lower quintiles. The benefits of intensive BP-lowering were larger among patients chronically exposed to PM2.5 levels above US National Ambient Air Quality Standards of 12 µg/m3 (hazard ratio, 0.47 [95% CI, 0.29–0.74]) compared with those living in cleaner locations (hazard ratio, 0.81 [95% CI, 0.68–0.97]), Pinteraction=0.037. This exploratory nonprespecified post hoc analysis of SPRINT suggests that the benefits of intensive BP lowering on the primary outcome was greater in patients exposed to higher PM2.5, suggesting that the magnitude of benefit may depend upon the magnitude of antecedent PM2.5 exposure.</abstract><cop>United States</cop><pub>American Heart Association, Inc</pub><pmid>33517683</pmid><doi>10.1161/HYPERTENSIONAHA.120.15923</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0001-6669-8163</orcidid><orcidid>https://orcid.org/0000-0001-7162-2972</orcidid><orcidid>https://orcid.org/0000-0002-1122-7695</orcidid><orcidid>https://orcid.org/0000-0002-8521-7262</orcidid><orcidid>https://orcid.org/0000-0002-9103-9343</orcidid></addata></record> |
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| ispartof | Hypertension (Dallas, Tex. 1979), 2021-03, Vol.77 (3), p.813-822 |
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| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8485988 |
| source | MEDLINE; American Heart Association Journals; EZB-FREE-00999 freely available EZB journals |
| subjects | Aged Air Pollutants - analysis Antihypertensive Agents - therapeutic use Cardiovascular Diseases - etiology Cardiovascular Diseases - physiopathology Cardiovascular Diseases - prevention & control Clinical Trials as Topic Environmental Exposure - adverse effects Female Humans Hypertension - drug therapy Hypertension - etiology Hypertension - physiopathology Male Middle Aged Outcome Assessment, Health Care - methods Outcome Assessment, Health Care - statistics & numerical data Particulate Matter - analysis Proportional Hazards Models Risk Factors |
| title | The Benefits of Intensive Versus Standard Blood Pressure Treatment According to Fine Particulate Matter Air Pollution Exposure: A Post Hoc Analysis of SPRINT |
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