Ambient PM _2.5 and Its Components Associated with Dynamic Progression from Different Blood Pressure States to Cardiovascular Diseases and Mortality: The GOLD-Health Cohort

The relationships between fine particulate matter (PM2.5) and the risk of hypertension (HTN) and cardiovascular disease (CVD) have been well documented. However, the associations between specific chemical constituents of PM2.5 and the dynamic progression of hypertensive CVD remain unclear. Using multistate models and mediation analyses in a cohort of 316,087 individuals, we investigated the associations between PM2.5, PM2.5 chemical components (sulfate [SO42–], nitrate [NO3–], ammonium [NH4+], organic matter [OM], and black carbon [BC]), and the dynamic progression from different blood pressure states to incident CVD and mortality. Our findings revealed that PM2.5 and its constituents were positively associated with the dynamic HTN progression. For example, with each interquartile range (IQR) increase, PM2.5, SO42–, NO3–, NH4+, OM, and BC were significantly associated with the disease transition from prehypertension (pre-HTN) to HTN, with hazard ratios (HRs) of 1.116 (95% confidence interval [CI]: 1.104–1.128), 1.186 (95% CI: 1.171–1.202), 1.179 (95% CI: 1.166–1.193), 1.171 (95% CI: 1.159–1.184), 1.155 (95% CI: 1.141–1.169), and 1.147 (95% CI: 1.133–1.161), respectively. Mediation analysis demonstrated that pre-HTN and HTN significantly mediated the relationships between PM2.5, PM2.5 components, and the increased risk of CVD and cardiovascular mortality. This study provides evidence that ambient PM2.5 and its chemical constituents may be important determinants in the dynamic progression of HTN. Controlling exposure to PM2.5 and its components, particularly during the pre-HTN phase, could be an effective strategy to curb the development of hypertensive CVD and alleviate its public health impact.