Association between PM2.5 exposure and blood pressure among young adults in Asia: systematic review and meta-analysis

Ambient air pollution, particularly fine particulate matter (PM2.5) and hypertension, are compounding public health challenges in low- and middle-income countries, contributing millions of premature deaths annually. Although several studies have explored the relationship between ambient air pollution and blood pressure, evidence remains limited for young adults. We performed a systematic review and meta-analysis to investigate the magnitude of associations between PM2.5 exposure and blood pressure among young adults residing in Asia. PubMed, Embase, and Scopus were searched for studies published up to December 2024. Eligible studies reported associations between PM2.5 and blood pressure in populations aged 18–45 years. Data were extracted on study characteristics and effect estimates. Pooled mean changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP) per 10 µg/m³ increase in PM2.5 were calculated using a random-effects model. Subgroup and sensitivity analyses were performed to explore potential sources of heterogeneity and study influence. Of 177 articles screened, 11 met the inclusion criteria. Overall, each 10 µg/m³ increase in PM2.5 was associated with a 1.13 mmHg rise in SBP (95% CI: 0.08–2.19) and a 0.38 mmHg rise in DBP (95% CI: − 0.18 to 0.94). Subgroup analysis indicated that long-term exposure was significantly associated with elevated DBP, suggesting a cumulative effect of prolonged PM2.5 exposure. Both short-term and long-term PM2.5 exposure was positively associated with blood pressure among young adults. These findings highlight novel evidence for overlooked population in previous reviews and underscore the need for targeted interventions and stricter air quality standards to protect cardiovascular health. As the evidence is primarily applicable to East Asian contexts, further research across other Asian regions is needed to establish broader generalizability. PROSPERO (Registration DOI: PROSPERO 2025 CRD42025642716).