Abstract
Although several studies have demonstrated a short-term association between outdoor temperature and blood pressure (BP) among various adult groups, evidence among children and adolescents is lacking. One hundred ninety-four thousand one hundred four participants from 2016 Health Promotion Program for Children and Adolescents (HPPCA) were analyzed through generalized linear mixed-effects models to estimate the short-term effects of two outdoor temperature variables (average and minimum temperature) on participants’ BP. Decreasing outdoor temperature was associated with significant increases in systolic BP (SBP), diastolic BP (DBP), and prevalence of hypertension during lag 0 through lag 6. Additionally, daily minimum temperature showed a more apparent association with participants’ BP. The estimated increases (95% confidence interval) in SBP and DBP at lag 0 were 0.82 (0.72, 0.92) mmHg and 2.28 (2.20, 2.35) mmHg for a 1 °C decrease in daily minimum temperature, while those values were 0.11 (0.10, 0.12) mmHg and 0.25 (0.24, 0.26) mmHg for a 1 °C decrease in daily average temperature, respectively. The effects of temperature on BP were stronger among female, as well as those with young age and low body mass index. It demonstrated that short-term decreases in outdoor temperature were significantly associated with rises in BP among children and adolescents. This founding has some implications for clinical management and research of BP. Meanwhile, public health intervention should be designed to reduce the exposure to cold temperature for protecting children and adolescents’ BP.
References
Alpérovitch A, Lacombe JM, Hanon O, Dartigues JF, Ritchie K, Ducimetière P, Tzourio C (2009) Relationship between blood pressure and outdoor temperature in a large sample of elderly individuals: the Three-City study. Arch Intern Med 169:75–80. https://doi.org/10.1001/archinternmed.2008.512
Argilés A, Mourad G, Mion C (1998) Seasonal changes in blood pressure in patients with end-stage renal disease treated with hemodialysis. N Engl J Med 339:1364–1370. https://doi.org/10.1056/NEJM199811053391904
Babisch W, Neuhauser H, Thamm M, Seiwert M (2009) Blood pressure of 8-14 year old children in relation to traffic noise at home—results of the German Environmental Survey for Children (GerES IV). Sci Total Environ 407:5839–5843. https://doi.org/10.1016/j.scitotenv.2009.08.016
Brennan PJ, Greenberg G, Miall WE, Thompson SG (1982) Seasonal variation in arterial blood pressure. Br Med J (Clin Res Ed) 285:919–923
Chen X, Wang Y (2008) Tracking of blood pressure from childhood to adulthood: a systematic review and meta-regression analysis. Circulation 117:3171–3180. https://doi.org/10.1161/CIRCULATIONAHA.107.730366
Chen R, Lu J, Yu Q, Peng L, Yang D, Wang C, Kan H (2015) The acute effects of outdoor temperature on blood pressure in a panel of elderly hypertensive patients. Int J Biometeorol 59:1791–1797. https://doi.org/10.1007/s00484-015-0987-9
Cooper RS, Kaufman JS, Bovet P (2017) Global burden of disease attributable to hypertension. JAMA 317:2017–2018. https://doi.org/10.1001/jama.2017.4213
Dong Y, Ma J, Song Y, Dong B, Wang Z, Yang Z, Wang X, Prochaska JJ (2017) National blood pressure reference for Chinese Han children and adolescents aged 7 to 17 years. Hypertension 70:897–906. https://doi.org/10.1161/HYPERTENSIONAHA.117.09983
Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, de Ferranti SD, Dionne JM, Falkner B, Flinn SK, Gidding SS, Goodwin C, Leu MG, Powers ME, Rea C, Samuels J, Simasek M, Thaker VV, Urbina EM (2017) Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics 140(3):e20171904
Giorgini P, Rubenfire M, Das R, Gracik T, Wang L, Morishita M, Bard RL, Jackson EA, Fitzner CA, Ferri C, Brook RD (2015) Particulate matter air pollution and ambient temperature: opposing effects on blood pressure in high-risk cardiac patients. J Hypertens 33:2032–2038. https://doi.org/10.1097/HJH.0000000000000663
Group of China Obesity Task F (2004) Body mass index reference norm for screening overweight and obesity in Chinese children and adolescents. Zhonghua liuxingbingxue zazhi 25:97–102 (in Chinese)
Halonen JI, Zanobetti A, Sparrow D, Vokonas PS, Schwartz J (2011) Relationship between outdoor temperature and blood pressure. Occup Environ Med 68:296–301. https://doi.org/10.1136/oem.2010.056507
Hampel R, Lepeule J, Schneider A, Bottagisi S, Charles MA, Ducimetière P, Peters A, Slama R (2011) Short-term impact of ambient air pollution and air temperature on blood pressure among pregnant women. Epidemiology 22:671–679. https://doi.org/10.1097/EDE.0b013e318226e8d6
Hermann JM, Rosenbauer J, Dost A, Steigleder-Schweiger C, Kiess W, Schöfl C, Holl RW, the DPV Initiative (2016) Seasonal variation in blood pressure in 162,135 patients with type 1 or type 2 diabetes mellitus. J Clin Hypertens (Greenwich) 18:270–278. https://doi.org/10.1111/jch.12743
Hoffmann B, Luttmann-Gibson H, Cohen A, Zanobetti A, de Souza C, Foley C, Suh HH, Coull BA, Schwartz J, Mittleman M, Stone P, Horton E, Gold DR (2012) Opposing effects of particle pollution, ozone, and ambient temperature on arterial blood pressure. Environ Health Perspect 120:241–246. https://doi.org/10.1289/ehp.1103647
Holm JC, Gamborg M, Neland M, Ward L, Gammeltoft S, Heitmann BL, Sørensen TIA, Ibsen KK (2012) Longitudinal changes in blood pressure during weight loss and regain of weight in obese boys and girls. J Hypertens 30:368–374. https://doi.org/10.1097/HJH.0b013e32834e4a87
Hu J, Chu GP, Huang FF, Zhou YK, Teng CG, Yang HB, Shen H (2016) Relation of body mass index (BMI) to the prevalence of hypertension in children: a 3years’ school-based prospective study in Suzhou, China. Int J Cardiol 222:270–274. https://doi.org/10.1016/j.ijcard.2016.07.217
Hu J, Shen H, Chu GP, Fu H, Huang FF, Zheng YM, Han D, Zhou YK, Wang Q, Wang B, Teng CG, Liu F, Yang HB (2017) Association of elevated resting pulse rate with increased risk of hypertension development in children: a prospective study in Suzhou, China. Medicine (Baltimore) 96:e7696. https://doi.org/10.1097/MD.0000000000007696
Jevons R, Carmichael C, Crossley A, Bone A (2016) Minimum indoor temperature threshold recommendations for English homes in winter—a systematic review. Public Health 136:4–12. https://doi.org/10.1016/j.puhe.2016.02.007
Johnson BD, Sackett JR, Sarker S, Schlader ZJ (2017) Face cooling increases blood pressure during central hypovolemia. Am J Physiol Regul Integr Comp Physio 313:R594–R600. https://doi.org/10.1152/ajpregu.00253.2017
Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J (2005) Global burden of hypertension: analysis of worldwide data. Lancet 365:217–223. https://doi.org/10.1016/S0140-6736(05)17741-1
Kim E, Park H, Hong YC, Ha M, Kim Y, Kim BN, Kim Y, Roh YM, Lee BE, Ryu JM, Kim BM, Ha EH (2014) Prenatal exposure to PM10 and NO2 and children’s neurodevelopment from birth to 24 months of age: Mothers and Children’s Environmental Health (MOCEH) study. Sci Total Environ 481:439–445. https://doi.org/10.1016/j.scitotenv.2014.01.107
Lanzinger S, Hampel R, Breitner S, Rückerl R, Kraus U, Cyrys J, Geruschkat U, Peters A, Schneider A (2014) Short-term effects of air temperature on blood pressure and pulse pressure in potentially susceptible individuals. Int J Hyg Environ Health 217:775–784. https://doi.org/10.1016/j.ijheh.2014.04.002
Lewington S, Li L, Sherliker P, Guo Y, Millwood I, Bian Z, Whitlock G, Yang L, Collins R, Chen J, Wu X, Wang S, Hu Y, Jiang L, Yang L, Lacey B, Peto R, Chen Z, China Kadoorie Biobank study collaboration (2012) Seasonal variation in blood pressure and its relationship with outdoor temperature in 10 diverse regions of China: the China Kadoorie Biobank. J Hypertens 30:1383–1391. https://doi.org/10.1097/HJH.0b013e32835465b5
Li Q, Guo Y, Wei DM, Song Y, Song JY, Ma J, Wang HJ (2016a) Does local ambient temperature impact children’s blood pressure? A Chinese National Survey. Environ Health 15(21):21. https://doi.org/10.1186/s12940-016-0119-y
Li Y, Hu J, Wu W, Liu S, Li M, Yao N, Chen J, Ye L, Wang Q, Zhou Y (2016b) Application of IEUBK model in lead risk assessment of children aged 61-84 months old in central China. Sci Total Environ 541:673–682. https://doi.org/10.1016/j.scitotenv.2015.09.103
Lin H, Guo Y, Zheng Y, di Q, Liu T, Xiao J, Li X, Zeng W, Cummings-Vaughn LA, Howard SW, Vaughn MG, Qian Z(M), Ma W, Wu F (2017) Long-term effects of ambient PM2.5 on hypertension and blood pressure and attributable risk among older Chinese adults. Hypertension 69:806–812. https://doi.org/10.1161/HYPERTENSIONAHA.116.08839
Lurbe E, Agabiti-Rosei E, Cruickshank JK, Dominiczak A, Erdine S, Hirth A, Invitti C, Litwin M, Mancia G, Pall D, Rascher W, Redon J, Schaefer F, Seeman T, Sinha M, Stabouli S, Webb NJ, Wühl E, Zanchetti A (2016) 2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents. J Hypertens 34:1887–1920. https://doi.org/10.1097/HJH.0000000000001039
Ma Z, Hu X, Sayer AM, Levy R, Zhang Q, Xue Y, Tong S, Bi J, Huang L, Liu Y (2016) Satellite-based spatiotemporal trends in PM2.5 concentrations: China, 2004-2013. Environ Health Perspect 124:184–192. https://doi.org/10.1289/ehp.1409481
Mamun AA, Lawlor DA, O'Callaghan MJ, Williams GM, Najman JM (2005) Effect of body mass index changes between ages 5 and 14 on blood pressure at age 14: findings from a birth cohort study. Hypertension 45:1083–1087. https://doi.org/10.1161/01.HYP.0000166720.18319.51
Mi J, Wang T, Meng L et al (2010) Development of blood pressure reference standards for Chinese children and adolescents. Chin J Evid Based Pediatr 5:4–14 (in Chinese)
Miersch A, Vogel M, Gausche R, Siekmeyer W, Pfaffle R, Dittrich K, Kiess W (2013) Influence of seasonal variation on blood pressure measurements in children, adolescents and young adults. Pediatr Nephrol 28:2343–2349. https://doi.org/10.1007/s00467-013-2562-0
Modesti PA (2013) Season, temperature and blood pressure: a complex interaction. Eur J Intern Med 24:604–607. https://doi.org/10.1016/j.ejim.2013.08.002
Modesti PA, Morabito M, Massetti L, Rapi S, Orlandini S, Mancia G, Gensini GF, Parati G (2013) Seasonal blood pressure changes: an independent relationship with temperature and daylight hours. Hypertension 61:908–914. https://doi.org/10.1161/HYPERTENSIONAHA.111.00315
Okada M, Kakehashi M (2014) Effects of outdoor temperature on changes in physiological variables before and after lunch in healthy women. Int J Biometeorol 58:1973–1981. https://doi.org/10.1007/s00484-014-0800-1
Portela A, Northrup G, Halberg F, Cornélissen G, Wendt H, Melby JC, Haus E (1996) Changes in human blood pressure with season, age and solar cycles: a 26 year record. Int J Biometeorol 39:176–181
Rose G (1961) Seasonal variation in blood pressure in man. Nature 189:235
Sheffield PE, Landrigan PJ (2011) Global climate change and children’s health: threats and strategies for prevention. Environ Health Perspect 119:291–298. https://doi.org/10.1289/ehp.1002233
Siqueira JCF, da Silva LB, Coutinho AS, Rodrigues RM (2017) Analysis of air temperature changes on blood pressure and heart rate and performance of undergraduate students. Work 57:43–54. https://doi.org/10.3233/WOR-172533
van den Hurk K, de Kort WL, Deinum J, Atsma F (2015) Higher outdoor temperatures are progressively associated with lower blood pressure: a longitudinal study in 100,000 healthy individuals. J Am Soc Hypertens 9:536–543. https://doi.org/10.1016/j.jash.2015.05.003
Wang Q, Li C, Guo Y, Barnett AG, Tong S, Phung D, Chu C, Dear K, Wang X, Huang C (2017a) Environmental ambient temperature and blood pressure in adults: a systematic review and meta-analysis. Sci Total Environ 575:276–286. https://doi.org/10.1016/j.scitotenv.2016.10.019
Wang S, Li M, Hua Z, Ye C, Jiang S, Wang Z, Song Z, Yu Y (2017b) Outdoor temperature and temperature maintenance associated with blood pressure in 438,811 Chinese adults. Blood Press 26:246–254. https://doi.org/10.1080/08037051.2017.1297676
Widlansky ME, Vita JA, Keyes MJ, Larson MG, Hamburg NM, Levy D, Mitchell GF, Osypiuk EW, Vasan RS, Benjamin EJ (2007) Relation of season and temperature to endothelium-dependent flow-mediated vasodilation in subjects without clinical evidence of cardiovascular disease (from the Framingham Heart Study). Am J Cardiol 100:518–523. https://doi.org/10.1016/j.amjcard.2007.03.055
Woodhouse PR, Khaw KT, Plummer M (1993) Seasonal variation of blood pressure and its relationship to ambient temperature in an elderly population. J Hypertens 11:1267-1274
Wu S, Deng F, Huang J, Wang X, Qin Y, Zheng C, Wei H, Shima M, Guo X (2015) Does ambient temperature interact with air pollution to alter blood pressure? A repeated-measure study in healthy adults. J Hypertens 33:2414–2421. https://doi.org/10.1097/HJH.0000000000000738
Xi B, Liang Y, Mi J (2013) Hypertension trends in Chinese children in the national surveys, 1993 to 2009. Int J Cardiol 165:577–579. https://doi.org/10.1016/j.ijcard.2012.09.032
Yang L, Li L, Lewington S, Guo Y, Sherliker P, Bian Z, Collins R, Peto R, Liu Y, Yang R, Zhang Y, Li G, Liu S, Chen Z, China Kadoorie Biobank Study Collaboration (2015) Outdoor temperature, blood pressure, and cardiovascular disease mortality among 23 000 individuals with diagnosed cardiovascular diseases from China. Eur Heart J 36:1178–1185. https://doi.org/10.1093/eurheartj/ehv023
Acknowledgments
We gratefully acknowledge all participating children and their parents for their collaboration.
Funding
This study was supported by the Youth Program of Reinvigorating the Health through Science and Education in Suzhou, China (kjxw2015035), and Program of Science and Technology for People’s Livelihood-Key Technology in Suzhou, China (ss201545).
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Hu, J., Shen, H., Teng, Cg. et al. The short-term effects of outdoor temperature on blood pressure among children and adolescents: finding from a large sample cross-sectional study in Suzhou, China. Int J Biometeorol 63, 381–391 (2019). https://doi.org/10.1007/s00484-019-01671-8
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DOI: https://doi.org/10.1007/s00484-019-01671-8