Investigating the association between ambient particulate matter (PM10) exposure and blood pressure values: Results from the link between the Portuguese Health Examination Survey and air quality data

INTRODUCTION AND OBJECTIVES

High blood pressure (BP) remains a major modifiable cardiovascular (CV) risk factor. Several epidemiologic studies have been performed to assess the association between air pollution exposure and this CV risk factor but results remain inconsistent. This study aims to estimate the effect of short-term PM₁₀ exposure (average previous three-day concentration) on diastolic (DBP) and systolic (SBP) blood pressure values of the resident mainland Portuguese population.

METHODS

Our study was based on available DBP and SBP data from 2272 participants from the first Portuguese Health Examination Survey (INSEF, 2015) living within a 30 km radius of at least one air quality monitoring station, with available measurements of particulate matter with an aerodynamic equivalent diameter ≤10 μm (PM₁₀). We used data from the air quality monitoring network of the Portuguese Environment Agency to obtain the individual allocated PM₁₀ concentrations. Generalized linear models were used to assess the effect of PM₁₀ exposure on DBP and SBP values.

RESULTS

No statistically significant association was found between PM₁₀ exposure and both DBP and SBP values (0.42% DBP change per 10 μg/m³ of PM₁₀ increment (95% confidence interval (CI): -0.85; 1.70) and 0.47% SBP change per 10 μg/m³ of PM₁₀ increment (95% CI: -0.86; 1.79)). Results remain unchanged after restricting the analysis to hypertensive or obese participants or changing the PM₁₀ assessment methodology.

CONCLUSIONS

In view of the PM₁₀ levels observed in 2015, our results suggests that exposure to PM₁₀ concentrations have a small or no effect on the blood pressure values. Other air pollutants and mixtures of pollutants that were not included in our study should considered in future studies.

Sociodemographic disparities in hypertension prevalence: Results from the first Portuguese National Health Examination Survey

INTRODUCTION

Cardiovascular disease is an important cause of death and disability worldwide, and hypertension is responsible for at least 45% of all deaths due to heart disease and 51% of deaths due to stroke. This study aimed to estimate and describe the distribution of prevalence, awareness, treatment and control of hypertension in the Portuguese population in 2015.

METHODS

A national survey using a representative sample of 4911 individuals residing in Portugal and aged between 25 and 74 years was implemented. Trained nurses performed a health interview and a physical examination, including blood pressure measurement (right arm, three measurements at 1-min intervals). The prevalence of hypertension was stratified by gender, age group, marital status, education, occupation and type of residential area. Associations between hypertension prevalence and sociodemographic factors were assessed using bivariate and multivariate Poisson regression.

RESULTS

The overall hypertension prevalence was 36.0%. The highest rates were observed in males (39.6%), in individuals aged between 65 and 74 years (71.3%), and in those with low levels of education (62.6%) and with no formal occupation (64.5%). Among hypertensive individuals, 69.8% were aware of their condition and 69.4% were under treatment, of whom 71.3% were controlled. Rates of awareness and medical treatment were significantly higher among women and older individuals.

CONCLUSIONS

A large majority of the adult Portuguese population are likely to reach blood pressure levels defined as hypertension in adulthood. Significant differences in hypertension prevalence were found according to gender, age and socioeconomic status, which highlights the importance of population strategies in public health policies.

Prevalence of overweight and obesity in Portugal: Results from the First Portuguese Health Examination Survey (INSEF 2015)

Obesity is recognised as a serious public health issue, due to its associated morbidity and mortality. This study aimed at estimating the prevalence of overweight and obesity in the Portuguese population through direct measurements obtained by the 1st National Health Examination Survey (INSEF 2015) and to identify its associated sociodemographic factors. INSEF was a nationally representative cross-sectional prevalence study conducted on 4911 Portuguese adults aged 25-74 years, in 2015. Height and weight were measured according to the European Health Examination Survey procedures. Poisson regression was used to estimate the adjusted prevalence ratios of overweight and obesity according to age, marital status, occupational activity, education, urbanization of living area and smoking status. Overall prevalences of overweight and obesity were 39.1% and 28.6%, respectively. The prevalence of overweight was higher among men (45.5% vs 33.2%) while the prevalence of obesity was higher among women (32% vs 25%). The sociodemographic factors associated with overweight and obesity were age, marital status and education. Smoking status was associated with overweight and obesity but only in women. INSEF suggests that a high prevalences of overweight and obesity are found in older individuals, married, with lower education levels and non-smoking women. Public health interventions are urgently required for obesity prevention, namely throughout health literacy strategies.