Using an Exposome-Wide Approach to Explore the Impact of Urban Environments on Blood Pressure among Adults in Beijing-Tianjin-Hebei and Surrounding Areas of China

Existing studies mostly explored the association between urban environmental exposures and blood pressure (BP) in isolation, ignoring correlations across exposures. This study aimed to systematically evaluate the impact of a wide range of urban exposures on BP using an exposome-wide approach. A multicenter cross-sectional study was conducted in ten cities of China. For each enrolled participant, we estimated their urban exposures, including air pollution, built environment, surrounding natural space, and road traffic indicator. On the whole, this study comprised three statistical analysis steps, that is, single exposure analysis, multiple exposure analysis and a cluster analysis. We also used deletion-substitution-addition algorithm to conduct variable selection. After considering multiple exposures, for hypertension risk, most significant associations in single exposure model disappeared, with only neighborhood walkability remaining negatively statistically significant. Besides, it was observed that SBP (systolic BP) raised gradually with the increase in PM2.5, but such rising pattern slowed down when PM2.5 concentration reached a relatively high level. For surrounding natural spaces, significant protective associations between green and blue spaces with BP were found. This study also found that high population density and public transport accessibility have beneficially significant association with BP. Additionally, with the increase in the distance to the nearest major road, DBP (diastolic BP) decreased rapidly. When the distance was beyond around 200 m, however, there was no obvious change to DBP anymore. By cluster analysis, six clusters of urban exposures were identified. These findings reinforce the importance of improving urban design, which help promote healthy urban environments to optimize human BP health.