Abstract
Higher level of blood pressure (BP) in winter than in summer has been observed, but the association between temperature and BP and its potential modifiers with adjustment of individual confounders and time trends was rarely explored. We aimed to investigate the association between outdoor temperature and BP and its potential modification factors in a longitudinal panel study in Shanghai, China. From January 2011 to December 2012, we scheduled 54 follow-ups for BP measurements per subject via home visit every other week for 50 elderly hypertensive patients. We applied linear mixed-effect models to analyze the association between temperature and BP after controlling for individual characteristics, antihypertensive medication, comorbidities, and time trends. We evaluated the potential effect modifiers by stratification analyses. For a 1 °C decrease in the average temperature on concurrent day and previous day, systolic BP increased by 0.19 mmHg (95 % confidence interval = 0.06, 0.31) and diastolic BP increased by 0.12 mmHg (95 % confidence interval = 0.03, 0.21). The effect of temperature on BP was stronger among those with older age, female sex, low socioeconomic status, and obese physique. The effect was weak and even null for those taking the angiotensin receptor blockers, angiotensin-converting enzyme inhibitor, or its combination with calcium antagonists. Further, the effect was almost restricted within those having chronic comorbidities. Our results demonstrated that an acute decrease in outdoor temperature was significantly associated with a rise in BP among elderly hypertensive patients, in Shanghai, China. Individual characteristics, antihypertensive medications, and comorbidities may modify this effect.
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Alperovitch A, Lacombe JM, Hanon O et al (2009) Relationship between blood pressure and outdoor temperature in a large sample of elderly individuals: the Three-City study. Arch Intern Med 169(1):75–80
Brennan PJ, Greenberg G, Miall WE et al (1982) Seasonal variation in arterial blood pressure. Br Med J (Clin Res Ed) 285(6346):919–923
Chen Q, Wang J, Tian J et al (2013a) Association between ambient temperature and blood pressure and blood pressure regulators: 1831 hypertensive patients followed up for three years. PLoS One 8(12):e84522
Chen R, Wang C, Meng X et al (2013b) Both low and high temperature may increase the risk of stroke mortality. Neurology 81(12):1064–1070
Chen R, Li T, Cai J et al (2014) Extreme temperatures and out-of-hospital coronary deaths in six large Chinese cities. J Epidemiol Community Health 68(12):1119–1124
Delfino RJ, Staimer N, Tjoa T et al (2008) Circulating biomarkers of inflammation, antioxidant activity, and platelet activation are associated with primary combustion aerosols in subjects with coronary artery disease. Environ Health Perspect 116(7):898–906
Goggins WB, Woo J, Ho S et al (2012) Weather, season, and daily stroke admissions in Hong Kong. Int J Biometeorol 56(5):865–872
Goggins WB, Chan EY, Yang CY (2013) Weather, pollution, and acute myocardial infarction in Hong Kong and Taiwan. Int J Cardiol 168(1):243–249
Halonen JI, Zanobetti A, Sparrow D et al (2011) Relationship between outdoor temperature and blood pressure. Occup Environ Med 68(4):296–301
Hampel R, Lepeule J, Schneider A et al (2011) Short-term impact of ambient air pollution and air temperature on blood pressure among pregnant women. Epidemiology 22(5):671–679
Hanna JM (1999) Climate, altitude, and blood pressure. Hum Biol 71(4):553–582
Hoffmann B, Luttmann-Gibson H, Cohen A et al (2012) Opposing effects of particle pollution, ozone, and ambient temperature on arterial blood pressure. Environ Health Perspect 120(2):241–246
Kimura T, Senda S, Masugata H et al (2010) Seasonal blood pressure variation and its relationship to environmental temperature in healthy elderly Japanese studied by home measurements. Clin Exp Hypertens 32(1):8–12
Lanzinger S, Hampel R, Breitner S et al (2014) Short-term effects of air temperature on blood pressure and pulse pressure in potentially susceptible individuals. Int J Hyg Environ Health 217(7):775–784
Lewington S, Li L, Sherliker P et al (2012) Seasonal variation in blood pressure and its relationship with outdoor temperature in 10 diverse regions of China: the China Kadoorie Biobank. J Hypertens 30(7):1383–1391
Lim SS, Vos T, Flaxman AD et al (2012) A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380(9859):2224–2260
Modesti PA, Morabito M, Massetti L et al (2013) Seasonal blood pressure changes: an independent relationship with temperature and daylight hours. Hypertension 61(4):908–914
Peng J, Kimura B, Phillips MI (2002) The predominant role of brain angiotensinogen and angiotensin in environmentally induced hypertension. Regul Pept 110(1):25–32
Rosenthal T (2004) Seasonal variations in blood pressure. Am J Geriatr Cardiol 13(5):267–272
Saeki K, Obayashi K, Iwamoto J et al (2014) Stronger association of indoor temperature than outdoor temperature with blood pressure in colder months. J Hypertens 32(8):1582–1589
Sun Z, Cade R, Morales C (2002) Role of central angiotensin II receptors in cold-induced hypertension. Am J Hypertens 15(1 Pt 1):85–92
Wichmann J, Ketzel M, Ellermann T et al (2012) Apparent temperature and acute myocardial infarction hospital admissions in Copenhagen, Denmark: a case-crossover study. Environ Health 11:19
Woodhouse PR, Khaw KT, Plummer M (1993) Seasonal variation of blood pressure and its relationship to ambient temperature in an elderly population. J Hypertens 11(11):1267–1274
Wu S, Deng F, Huang J et al (2013) Blood pressure changes and chemical constituents of particulate air pollution: results from the Healthy Volunteer Natural Relocation (HVNR) study. Environ Health Perspect 121(1):66–72
Acknowledgments
This study was supported by Xuhui Science & Technology Committee (SHXH201030), Shanghai Key Laboratory of Meteorology and Health (QXJK201304), Public Welfare Research Program of National Health and Family Planning Commission of China (201402022), Cyrus Tang Foundation (CTF-FD2014001), and Consulting service for center of excellence in Global Health Policy Development and Governance in China (GHSP-CS-OP3-02).
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Renjie Chen and Jianxiong Lu contributed equally to this work.
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Chen, R., Lu, J., Yu, Q. et al. The acute effects of outdoor temperature on blood pressure in a panel of elderly hypertensive patients. Int J Biometeorol 59, 1791–1797 (2015). https://doi.org/10.1007/s00484-015-0987-9
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DOI: https://doi.org/10.1007/s00484-015-0987-9