title: Relationship between daily exposure to biomass fuel smoke and blood pressure in high-altitude Peru.
abstract: Household air pollution from biomass fuel use affects 3 billion people worldwide; however, few studies have examined the relationship between biomass fuel use and blood pressure. We sought to determine if daily biomass fuel use was associated with elevated blood pressure in high altitude Peru and if this relationship was affected by lung function. We analyzed baseline information from a population-based cohort study of adults aged ≥ 35 years in Puno, Peru. Daily biomass fuel use was self-reported. We used multivariable regression models to examine the relationship between daily exposure to biomass fuel smoke and blood pressure outcomes. Interactions with sex and quartiles of forced vital capacity were conducted to evaluate for effect modification. Data from 1004 individuals (mean age, 55.3 years; 51.7% women) were included. We found an association between biomass fuel use with both prehypertension (adjusted relative risk ratio, 5.0; 95% confidence interval, 2.6-9.9) and hypertension (adjusted relative risk ratio, 3.5; 95% confidence interval, 1.7-7.0). Biomass fuel users had a higher systolic blood pressure (7.0 mm Hg; 95% confidence interval, 4.4-9.6) and a higher diastolic blood pressure (5.9 mm Hg; 95% confidence interval, 4.2-7.6) when compared with nonusers. We did not find interaction effects between daily biomass fuel use and sex or percent predicted forced vital capacity for either systolic blood pressure or diastolic blood pressure. Biomass fuel use was associated with a higher likelihood of having hypertension and higher blood pressure in Peru. Reducing exposure to household air pollution from biomass fuel use represents an opportunity for cardiovascular prevention.
authors.affiliation: From the Division of Cardiology, Department of Medicine and Duke Clinical Research Institute, Duke University, Durham, NC (M.B.P., E.J.V.); Biomedical Research Unit, A.B. PRISMA, Lima, Peru (K.M.R.); Division of Cardiology, Department of Medicine, Washington University, St. Louis, MO (V.G.D.-R.); Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (R.H.G.) and Division of Pulmonary and Critical Care Medicine, School of Medicine (R.A.W., W.C.), Johns Hopkins University, Baltimore, MD; and CRONICAS Center of Excellence in Chronic Diseases (R.H.G., J.J.M., W.C.) and Department of Medicine (J.J.M.), Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Melissa
authors.initials: M
authors.lastname: Burroughs Peña
authors.affiliation: From the Division of Cardiology, Department of Medicine and Duke Clinical Research Institute, Duke University, Durham, NC (M.B.P., E.J.V.); Biomedical Research Unit, A.B. PRISMA, Lima, Peru (K.M.R.); Division of Cardiology, Department of Medicine, Washington University, St. Louis, MO (V.G.D.-R.); Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (R.H.G.) and Division of Pulmonary and Critical Care Medicine, School of Medicine (R.A.W., W.C.), Johns Hopkins University, Baltimore, MD; and CRONICAS Center of Excellence in Chronic Diseases (R.H.G., J.J.M., W.C.) and Department of Medicine (J.J.M.), Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Karina M
authors.initials: KM
authors.lastname: Romero
authors.affiliation: From the Division of Cardiology, Department of Medicine and Duke Clinical Research Institute, Duke University, Durham, NC (M.B.P., E.J.V.); Biomedical Research Unit, A.B. PRISMA, Lima, Peru (K.M.R.); Division of Cardiology, Department of Medicine, Washington University, St. Louis, MO (V.G.D.-R.); Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (R.H.G.) and Division of Pulmonary and Critical Care Medicine, School of Medicine (R.A.W., W.C.), Johns Hopkins University, Baltimore, MD; and CRONICAS Center of Excellence in Chronic Diseases (R.H.G., J.J.M., W.C.) and Department of Medicine (J.J.M.), Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Velazquez
authors.affiliation: From the Division of Cardiology, Department of Medicine and Duke Clinical Research Institute, Duke University, Durham, NC (M.B.P., E.J.V.); Biomedical Research Unit, A.B. PRISMA, Lima, Peru (K.M.R.); Division of Cardiology, Department of Medicine, Washington University, St. Louis, MO (V.G.D.-R.); Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (R.H.G.) and Division of Pulmonary and Critical Care Medicine, School of Medicine (R.A.W., W.C.), Johns Hopkins University, Baltimore, MD; and CRONICAS Center of Excellence in Chronic Diseases (R.H.G., J.J.M., W.C.) and Department of Medicine (J.J.M.), Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Victor G
authors.initials: VG
authors.lastname: Davila-Roman
authors.affiliation: From the Division of Cardiology, Department of Medicine and Duke Clinical Research Institute, Duke University, Durham, NC (M.B.P., E.J.V.); Biomedical Research Unit, A.B. PRISMA, Lima, Peru (K.M.R.); Division of Cardiology, Department of Medicine, Washington University, St. Louis, MO (V.G.D.-R.); Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (R.H.G.) and Division of Pulmonary and Critical Care Medicine, School of Medicine (R.A.W., W.C.), Johns Hopkins University, Baltimore, MD; and CRONICAS Center of Excellence in Chronic Diseases (R.H.G., J.J.M., W.C.) and Department of Medicine (J.J.M.), Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Gilman
authors.affiliation: From the Division of Cardiology, Department of Medicine and Duke Clinical Research Institute, Duke University, Durham, NC (M.B.P., E.J.V.); Biomedical Research Unit, A.B. PRISMA, Lima, Peru (K.M.R.); Division of Cardiology, Department of Medicine, Washington University, St. Louis, MO (V.G.D.-R.); Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (R.H.G.) and Division of Pulmonary and Critical Care Medicine, School of Medicine (R.A.W., W.C.), Johns Hopkins University, Baltimore, MD; and CRONICAS Center of Excellence in Chronic Diseases (R.H.G., J.J.M., W.C.) and Department of Medicine (J.J.M.), Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Wise
authors.affiliation: From the Division of Cardiology, Department of Medicine and Duke Clinical Research Institute, Duke University, Durham, NC (M.B.P., E.J.V.); Biomedical Research Unit, A.B. PRISMA, Lima, Peru (K.M.R.); Division of Cardiology, Department of Medicine, Washington University, St. Louis, MO (V.G.D.-R.); Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (R.H.G.) and Division of Pulmonary and Critical Care Medicine, School of Medicine (R.A.W., W.C.), Johns Hopkins University, Baltimore, MD; and CRONICAS Center of Excellence in Chronic Diseases (R.H.G., J.J.M., W.C.) and Department of Medicine (J.J.M.), Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: J Jaime
authors.initials: JJ
authors.lastname: Miranda
authors.affiliation: From the Division of Cardiology, Department of Medicine and Duke Clinical Research Institute, Duke University, Durham, NC (M.B.P., E.J.V.); Biomedical Research Unit, A.B. PRISMA, Lima, Peru (K.M.R.); Division of Cardiology, Department of Medicine, Washington University, St. Louis, MO (V.G.D.-R.); Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (R.H.G.) and Division of Pulmonary and Critical Care Medicine, School of Medicine (R.A.W., W.C.), Johns Hopkins University, Baltimore, MD; and CRONICAS Center of Excellence in Chronic Diseases (R.H.G., J.J.M., W.C.) and Department of Medicine (J.J.M.), Universidad Peruana Cayetano Heredia, Lima, Peru. wcheckl1@jhmi.edu.
authors.forename: William
authors.initials: W
authors.lastname: Checkley
mesh_terms: D000328:Adult; D000368:Aged; D016902:Air Pollution, Indoor / Q000009:adverse effects*; D000531:Altitude; D018533:Biomass; D001794:Blood Pressure; D018876:Environmental Illness / Q000150:complications* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000209:etiology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010568:Peru / Q000453:epidemiology; D012424:Rural Population; D012906:Smoke / Q000009:adverse effects*
chemical_list: D012906:Smoke
keywords: Latin America; air pollution; blood pressure; global health; health status disparities; indoor air pollution; rural health