EFECTES DE LA CONTAMINACIÓ ATMOSFÈRICA SOBRE LA PRESSIÓ ARTERIAL AMBULATÒRIA

Abstract

INTRODUCTION: Air particulate matters and nitrogen dioxide and sulfur dioxide are the most worrying pollutants, with the greatest impact on public health. There are studies that relate atmospheric pollution with the increase in office blood pressure, but there is no study that relates air pollution with 24h ambulatory blood pressure monitoring (ABPM). _x000D_ _x000D_ OBJECTIVES: the main objective is to know the relationship between ABPM and atmospheric pollutants that are measured regularly (PM10, PM2,5, NO2 and SO2) and the most recent measurement (ultrafine particles, PUF) in the metropolitan area of Barcelona._x000D_ Secondary objectives are to quantify the effects of atmospheric pollution on daily, daytime and nighttime average blood pressure values. To know the relationship between ambient temperature and ABPM. To evaluate the association between air pollution and clinical blood pressure._x000D_ _x000D_ PATIENTS AND METHODS: Design. Observational study of temporary and geographic measures of individual patients (case-time series design). Area of ​​study. Primary Care Centers and Hypertension Units in the metropolitan area of ​​Barcelona. Population. Hypertensive patients ≥ 18 years, without pharmacological treatment, with a first valid ABPM registered in the CARDIORISC database of the SEH-LELHA during the period 2005-2014. Variables included from CARDIORISC, from ​​the data provided by the Departament de Territori i Sostenibilitat de la Generalitat de Catalunya and by the Institute of Environmental Diagnosis and Water Studies of the Superior Council of Scientific Research in Barcelona. Analysis of regression of temporal series adjusted by individual variables (sociodemographic and concomitant pathology) and ecological (ambient temperature)._x000D_ RESULTS: Inclusion of 2,888 patients. Mean age of 54,3 (DS 14,6) years and 50,1% are women. Body Mass Index (BMI) 28.8 kg/m2 (DS 6.4) and 16.9% of the sample smokes. Baseline 24h ABPM 128.0 (12.7) / 77.4 (9.7) mmHg and 46.1% of the sample is well controlled. Women have low BP compared to men (both ABPM and office BP); an increase in Systolic BP (SBP) with age is described; also an increase in BP (all SBP and DBP, night and office BP) with higher BMI; smokers have BP values higher than non-smokers and a decrease in DBP (both ABPM and office BP) is seen in association with DM2. There is a non-linear relationship between ambient temperature (Ta) and SBP, with a threshold value at 15°C. In DBP, the increase in a degree of Ta is associated with a decrease in 24h DBP in 0.16 mmHg (p = 0.259), daytime-DBP in 0.18 mmHg (p = 0.021), nighttime-DBP in 0.11 mmHg (p = 0.154) and office DBP in 0.22 mmHg (p = 0.040). For each increase of 10μg/m3 of PM10 an increase of 1.37 mmHg in 24h DBP and 1.48 mmHg in daytime-DBP was observed, statistically significant. For each increase of 1 μg/m3 of PUF 24h DBP increases in 1.46 mmHg and daytime-DBP in 1.56 mmHg, statistically significant. No statistical relationship was found between pollutants PM2.5, NO2 and SO2 with ABPM. No statistical relationship was found between any pollutant and office BP. _x000D_ _x000D_ CONCLUSIONS: The concentration of PM10 and PUF in our area of study is significantly associated with an increase in 24h DBP and daytime-DBP. But there has been no association between pollutants of PM2.5, NO2 and SO2 with BP (ABPM and office BP). For each degree that increases the ambient temperature in the metropolitan area of Barcelona, systolic and diastolic BP decreases in all situations (24h, daytime, nighttime and office BP).

Date of Award	22 Nov 2017
Original language	Catalan
Supervisor	Ernest Vinyoles Bargalló (Director) & Aurelio Miguel Tobias Garces (Director)