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Ambient Particulate Air Pollution and Blood Pressure in Peri-urban India

Curto, Ariadnaa; Wellenius, Gregory A.b; Milà, Carlesa; Sanchez, Margauxa; Ranzani, Otavioa; Marshall, Julian D.c; Kulkarni, Bharatid; Bhogadi, Santhie; Kinra, Sanjayf; Tonne, Cathryna

doi: 10.1097/EDE.0000000000001014
Air Pollution

Background: Evidence linking long-term exposure to particulate air pollution to blood pressure (BP) in high-income countries may not be transportable to low- and middle-income countries. We examined cross-sectional associations between ambient fine particulate matter (PM2.5) and black carbon (BC) with BP (systolic [SBP] and diastolic [DBP]) and prevalent hypertension in adults from 28 peri-urban villages near Hyderabad, India.

Methods: We studied 5531 participants from the Andhra Pradesh Children and Parents Study (18–84 years, 54% men). We measured BP (2010–2012) in the right arm and defined hypertension as SBP ≥130 mmHg and/or DBP ≥80 mmHg. We used land-use regression models to estimate annual average PM2.5 and BC at participant’s residence. We applied linear and logistic nested mixed-effect models stratified by sex and adjusted by cooking fuel type to estimate associations between within-village PM2.5 or BC and health.

Results: Mean (SD) PM2.5 was 33 µg/m3 (2.7) and BC was 2.5 µg/m3 (0.23). In women, a 1 µg/m3 increase in PM2.5 was associated with 1.4 mmHg higher SBP (95% confidence interval [CI]: 0.12, 2.7), 0.87 mmHg higher DBP (95% CI: −0.18, 1.9), and 4% higher odds of hypertension (95% CI: 0%, 9%). In men, associations with SBP (0.52 mmHg; 95% CI: −0.82, 1.8), DBP (0.41 mmHg; 95% CI: −0.69, 1.5), and hypertension (2% higher odds; 95% CI: −2%, 6%) were weaker. No associations were observed with BC.

Conclusion: We observed a positive association between ambient PM2.5 and BP and hypertension in women. Longitudinal studies in this region are needed to corroborate our findings.

From the aISGlobal, Universitat Pompeu Fabra, CIBER Epidemiología y Salud Pública, Barcelona, Spain

bDepartment of Epidemiology, Brown University School of Public Health, RI

cDepartment of Civil and Environmental Engineering, University of Washington, WA

dNational Institute of Nutrition, Indian Council of Medical Research, Hyderabad, India

ePublic Health Foundation of India, Indian Institute for Public Health, Hyderabad, India

fDepartment of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.

Submitted June 13, 2018; accepted March 19, 2019.

Supported by grants 084674/Z from the Wellcome Trust, 336167 from the European Research Council, and RYC-2015–17402 to investigator CT from the Spanish Ministry of Economy and Competitiveness.

The authors report no conflicts of interest.

Data is available through a formal collaborator request to APCAPS (see: The computing code required to replicate the results reported is by contacting the corresponding author.

Supplemental digital content is available through direct URL citations in the HTML and PDF versions of this article (

Correspondence: Cathryn Tonne, ISGlobal- Campus Mar, Barcelona Biomedical Research Park (PRBB), Doctor Aiguader 88, 1st floor, 08003 Barcelona, Spain. E-mail:

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