Air Pollution Elevates the Risks of Incident Hypertension, Subsequent Comorbidities Progression, and Prognosis: A Multistate Analysis.

Abstract

Long-term exposure to air pollution has been associated with incident hypertension; however, its role in the progression and prognosis of subsequent comorbidities remains poorly understood. Using data from the UK Biobank (participants enrolled between 2006 and 2010), this study used a multistate model to examine the effects of fine particulate matter, inhalable particulate matter, nitrogen oxides, and nitrogen dioxide on hypertension progression trajectories and to investigate potential mediators. Comorbidities included ischemic heart disease, atherosclerosis, heart failure, arrhythmia, hypertensive heart and kidney disease, cardiac arrest, aneurysm and aortic dissection, stroke, dementia, depression, glaucoma, retinal vascular occlusion, and chronic kidney disease. Data were analyzed in 2024. A total of 272,245 participants free of hypertension and related comorbidities were included at baseline. During a median follow-up of 14.8 years, 33,021 individuals were diagnosed with hypertension; 7,494 developed hypertension comorbidities; and 1,141 died after experiencing comorbidities. An IQR increase in annual levels of fine particulate matter, nitrogen dioxide, and nitrogen oxides was associated with an increased risk of hypertension progression trajectories (from baseline to hypertension, hypertension to comorbidities, and comorbidities to death), with hazard ratios ranging from 1.03 to 1.09, from 1.07 to 1.19, and from 1.05 to 1.10, respectively. Pollution promoted the progression of hypertension to cardiovascular and renal comorbidities, particularly ischemic heart disease, atherosclerosis, and chronic kidney disease, ultimately contributing to an increased risk of mortality. BMI and lung function mediated 7.7%-25.3% of the associations between nitrogen oxides and both the onset of hypertension and its progression to comorbidities. This study offers actionable insights for the targeted prevention and management of hypertension, underscoring the need for clean air policies and the imperative to monitor hypertension as a dynamic continuum.