Portable Air Cleaners and Home Systolic Blood Pressure in Adults With Hypertension Living in New York City Public Housing.

HomeJournal of the American Heart AssociationAhead of PrintPortable Air Cleaners and Home Systolic Blood Pressure in Adults With Hypertension Living in New York City Public Housing Open AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citations ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toOpen AccessLetterPDF/EPUBPortable Air Cleaners and Home Systolic Blood Pressure in Adults With Hypertension Living in New York City Public Housing Sharine Wittkopp, Elle Anastasiou, Jiyuan Hu, Mengling Liu, Aisha T. Langford, Robert D. Brook, Terry Gordon, Lorna E. Thorpe and Jonathan D. Newman Sharine WittkoppSharine Wittkopp https://orcid.org/0000-0002-5122-8123 , Leon H. Charney Division of Cardiology, , New York University, Grossman School of Medicine, , New York, , NY, , USA, Search for more papers by this author , Elle AnastasiouElle Anastasiou , Department of Population Health, , New York University, Grossman School of Medicine, , New York, , NY, , USA, Search for more papers by this author , Jiyuan HuJiyuan Hu , Division of Biostatistics, , New York University, Grossman School of Medicine, , New York, , NY, , USA, Search for more papers by this author , Mengling LiuMengling Liu https://orcid.org/0000-0001-9758-8522 , Division of Biostatistics, , New York University, Grossman School of Medicine, , New York, , NY, , USA, Search for more papers by this author , Aisha T. LangfordAisha T. Langford https://orcid.org/0000-0003-1758-691X , Department of Population Health, , New York University, Grossman School of Medicine, , New York, , NY, , USA, Search for more papers by this author , Robert D. BrookRobert D. Brook https://orcid.org/0000-0002-8521-7262 , Division of Cardiovascular Diseases, , Wayne State University, , Detroit, , MI, , USA, Search for more papers by this author , Terry GordonTerry Gordon , Department of Environmental Medicine, , New York University, Grossman School of Medicine, , New York, , NY, , USA, Search for more papers by this author , Lorna E. ThorpeLorna E. Thorpe https://orcid.org/0000-0002-5535-2674 , Department of Population Health, , New York University, Grossman School of Medicine, , New York, , NY, , USA, Search for more papers by this author and Jonathan D. NewmanJonathan D. Newman *Correspondence to: Jonathan D. Newman, MD, MPH, New York University, Grossman School of Medicine, NYU Translational Research Bldg, Suite 853, 227 E 30th St, New York, NY 10016. Email: E-mail Address: [email protected] https://orcid.org/0000-0001-6855-7305 , Leon H. Charney Division of Cardiology, , New York University, Grossman School of Medicine, , New York, , NY, , USA, Search for more papers by this author Originally published29 Jun 2023https://doi.org/10.1161/JAHA.123.029697Journal of the American Heart Association. 2023;0:e029697Hypertension is the leading modifiable cardiovascular risk factor globally,1 with ≈25% of cardiovascular events attributed to hypertension. A large body of evidence supports that exposure to particulate matter air pollution, especially fine particulate matter (PM2.5), increases blood pressure (BP) and promotes hypertension.2Portable air cleaners (PACs) are an individual‐level intervention to decrease air pollution exposure. In our recent meta‐analysis, PACs reduced systolic BP by 4 mm Hg over a median of 6 (interquartile range, 2–14) days.3 Studies to date did not use self‐measured home BP, a stronger predictor of cardiovascular risk and more accurate estimate of 24‐hour BP than office BP.4 In addition, there is a dearth of evidence on the effects of PACs to reduce air pollution exposure and lower BP specifically in underresourced communities.To address this gap and inform design of future trials, we conducted a randomized, double‐blind, sham‐controlled, pilot trial of PACs on self‐measured home blood pressure in adults with hypertension living in urban public housing. We hypothesized that continuous bedroom PAC use would reduce self‐measured morning (am) home systolic BP (H‐SBP) in an urban cohort of adults with hypertension. The data used in this study are available from the corresponding author on reasonable request. We enrolled 20 English‐ or Spanish‐speaking, nonsmoking adults with self‐reported hypertension from nonsmoking apartments in New York City public housing. Exclusion criteria included normal BP without antihypertensive medications or an enrollment visit BP >160/100 mm Hg. Participants were randomized in a 1:1 ratio to active versus sham PACs (without high efficiency particulate air filters). PACs were placed in participant bedrooms (or primary sleeping space, if studio apartments). Sham and active units were identical in appearance and sound. This study was approved by the NYU Grossman School of Medicine Institutional Review Board, and all subjects provided informed consent.Participants measured home BP twice each morning, 1 minute apart, following American Heart Association guidelines. Deidentified measurements were transmitted to an online dashboard. A 3‐day run‐in phase was used to confirm eligibility. PACs were used continuously for 14 days. We used publicly available ambient outdoor PM2.5 concentration from New York State Department of Environmental Conservation monitoring stations within 1 km of home for background PM2.5. Indoor sources of PM2.5 were determined by self‐report. We analyzed outdoor mean (±SD) concentrations of PM2.5. We defined baseline am H‐SBP as the per‐person average in am H‐SBP measured during run‐in phase. Treatment phase am H‐SBP was the average per person of all am H‐SBP during treatment. Independent t‐tests compared (1) baseline am H‐SBP by arm, (2) treatment phase am H‐SBP by arm, and (3) difference in am H‐SBP between baseline and treatment phase by arm.Study cohort included 20 non‐White adults (who self‐identified as non‐Hispanic Black, Hispanic or Latino, Asian, or American Indian or Alaska Native), 70% women, with mean (±SD) age of 55 (±14) years; the mean (±SD) body mass index was 33.7 (±6.2) kg/m2. Of the cohort, 65% had hypertension for >10 years; 85% reported antihypertensive medication use. Average ambient outdoor PM2.5 during run‐in phase was lower for active versus sham (5.1±0.1 versus 6.0±0.27 μg/m3; P<0.0001; Figure [A]), whereas during intervention, there was no difference in PM2.5 by arm (5.5±0.2 versus 5.75±0.1 μg/m3; P=0.24). All participants reported comparable exposures to known sources of indoor particulate matter.Download figureDownload PowerPointFigure 1. Outdoor fine particulate matter (PM2.5) and home systolic blood pressure (BP) during run‐in and treatment phases.A, Average outdoor PM2.5 by study arm during run‐in and treatment phases (representative time points shown; bars represent SD). B, Average systolic BP by study arm during run‐in and treatment phases (representative time points shown; bars represent SD).During run‐in phase, baseline am H‐SBP was similar for participants randomized to active (133.6±1.99 mm Hg) versus sham (137.2±1.7 mm Hg) PACs (P=0.24). During treatment, there was a nonsignificant trend for a lower am H‐SBP for active (129.6±8.9 mm Hg) versus sham (134.6±9.6 mm Hg; P=0.25; Figure [B]). There was also a nonsignificant difference in am H‐SBP from baseline to treatment for participants randomized to active (5.67±10.08 mm Hg) versus sham (2.18±9.16 mm Hg) PACs (P=0.25).In a cohort of nonsmoking adults with hypertension residing in public housing, there was a nonsignificant decrease in am H‐SBP over 14 days with PACs. The magnitude of BP reduction achieved with PACs among adults with hypertension could meaningfully reduce cardiovascular disease morbidity and mortality if sustained on a population level.5 Limitations of this pilot study include cohort size and inability to source apportion and characterize PM2.5 composition. Also, because of cohort size, we were underpowered to investigate if the effects of PAC use on BP were mediated by reductions in PM2.5. Findings from this pilot study can be used to inform the design of future studies to establish use of PACs as a viable personal intervention to reduce the cardiovascular effects of air pollution.Sources of FundingPilot funding for this study was provided by the NYU Grossman School of Medicine Cardiovascular Research Center.DisclosuresNone.Footnotes*Correspondence to: Jonathan D. Newman, MD, MPH, New York University, Grossman School of Medicine, NYU Translational Research Bldg, Suite 853, 227 E 30th St, New York, NY 10016. Email: jonathan.[email protected]orgThis work was presented in part at the Society for Epidemiologic Research Conference, June 14 to 17, 2022.This article was sent to Kori S. Zachrison, MD, MSc, Associate Editor, for review by expert referees, editorial decision, and final disposition.For Sources of Funding and Disclosures, see page 3.References1 Roth GA, Mensah GA, Johnson CO, Addolorato G, Ammirati E, Baddour LM, Barengo NC, Beaton AZ, Benjamin EJ, Benziger CP, et al. Global burden of cardiovascular diseases and risk factors, 1990‐2019: update from the GBD 2019 study. J Am Coll Cardiol. 2020; 76:2982–3021. doi: 10.1016/j.jacc.2020.11.010CrossrefMedlineGoogle Scholar2 Yang BY, Qian Z, Howard SW, Vaughn MG, Fan SJ, Liu KK, Dong GH. Global association between ambient air pollution and blood pressure: a systematic review and meta‐analysis. Environ Pollut. 2018; 235:576–588. doi: 10.1016/j.envpol.2018.01.001CrossrefMedlineGoogle Scholar3 Walzer D, Gordon T, Thorpe L, Thurston G, Xia Y, Zhong H, Roberts TR, Hochman JS, Newman JD. Effects of home particulate air filtration on blood pressure: a systematic review. Hypertension. 2020; 76:44–50. doi: 10.1161/HYPERTENSIONAHA.119.14456LinkGoogle Scholar4 Niiranen TJ, Hanninen MR, Johansson J, Reunanen A, Jula AM. Home‐measured blood pressure is a stronger predictor of cardiovascular risk than office blood pressure: the Finn‐Home study. Hypertension. 2010; 55:1346–1351. doi: 10.1161/HYPERTENSIONAHA.109.149336LinkGoogle Scholar5 Whelton PK, He J, Appel LJ, Cutler JA, Havas S, Kotchen TA, Roccella EJ, Stout R, Vallbona C, Winston MC, et al. Primary prevention of hypertension: clinical and public health advisory from the National High Blood Pressure Education Program. JAMA. 2002; 288:1882–1888. doi: 10.1001/jama.288.15.1882CrossrefMedlineGoogle Scholar eLetters(0)eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. Comments should be no longer than 500 words and will only be posted online. References are limited to 10. Authors of the article cited in the comment will be invited to reply, as appropriate.Comments and feedback on AHA/ASA Scientific Statements and Guidelines should be directed to the AHA/ASA Manuscript Oversight Committee via its Correspondence page.Sign In to Submit a Response to This Article Previous Back to top Next FiguresReferencesRelatedDetails Article InformationMetrics Copyright © 2023 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley BlackwellThis is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.https://doi.org/10.1161/JAHA.123.029697PMID: 37382099 Manuscript receivedMarch 17, 2023Manuscript acceptedMay 23, 2023Originally publishedJune 29, 2023 Keywordsair filtrationpublic housingrisk factorsblood pressureparticulate matter air pollutionPDF download SubjectsRisk Factors