AirPressureNYC: Reducing AIR pollution to lower blood PRESSURE among New York City public housing residents

AirPressureNYC：减少空气污染以降低纽约市公共住房居民的血压

基本信息

批准号：
10638946
负责人：
JONATHAN D NEWMAN
金额：
$ 80.18万
依托单位：
NEW YORK UNIVERSITY SCHOOL OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-07-15 至 2028-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10638946
关键词：
Address Adherence Adult Age Air Pollutants Air Pollution American Attention Autonomic Dysfunction Biological Blood Blood Pressure Cardiovascular Diseases Cessation of life Clinical Clinical Trials Cohort Studies Communities Consensus Data Disparity Dose Double-Blind Method Effectiveness Ensure Environment Epidemic Exposure to Face Fingers Goals Health High Prevalence Home Hour Housing Humidity Hypertension Individual Indoor Air Pollution Inequity Inflammatory Interleukin-1 beta Interleukin-6 Intervention Knowledge Link Measurement Measures Mediating Meta-Analysis Monitor Morbidity - disease rate National Heart, Lung, and Blood Institute New York City Non obese Obesity Outcome Particulate Pathway interactions Patients Persons Pharmaceutical Preparations Physiological Pollution Population Populations at Risk Predictive Factor Proteins Public Health Public Housing Public Policy Randomized Research Personnel Resources Risk Factors Seasons Specific qualifier value Spottings Strategic vision Temperature Testing Time Twin Multiple Birth Urban Community Vascular Diseases Vulnerable Populations adult obesity air cleaner ambient air pollution biological adaptation to stress blood pressure elevation blood pressure reduction cardiovascular disorder risk cardiovascular effects cardiovascular health clinically relevant cohort cytokine design experience fine particles health inequalities high risk hypertensive innovation meter mortality non-smoker novel novel strategies obese person patient response portability primary endpoint response secondary endpoint sex success systemic inflammatory response treatment arm urban underserved

项目摘要

PROJECT ABSTRACT Air pollution is responsible for >213,000 excess deaths in the U.S. annually, and globally remains the 4th leading cause of mortality. Further, most air pollution-related mortality is due to cardiovascular (CV) disease. We and others have found that short term air pollution exposure increases systolic blood pressure (SBP) by 2- 10 mmHg, while longer term exposure promotes the onset of hypertension (HTN)—which represents a key pathway from air pollution exposure to risk of CV disease. However, there is a gap in evidence in support of personal strategies to reduce the adverse CV effects of air pollution, and consensus required to change public policy on air pollution remains elusive. Until this evidence gap is addressed, air pollution exposure will remain a potentially modifiable yet untreated risk factor for HTN and subsequent CV disease. In this context, the overall objective of our proposal is to perform a pivotal clinical trial to test personal air cleaners (PACs) in indoor settings to reduce fine particulate air pollution <2.5 µM (PM2.5)—the most vasculotoxic component of air pollution—and lower SBP among a cohort of adults with treated and untreated HTN. Data from our group and others show that PACs lower SBP by 3-5 mmHg over 3-10 days, have larger (≈8mmHg) reductions in SBP among obese adults, and that these benefits may be driven by reductions in inflammatory cytokines. Under- resourced communities—such as urban public housing residents—experience both indoor and outdoor air pollution inequities, excess burdens of obesity and HTN, and are at high risk for the persistent adverse health effects from PM2.5 exposure. We hypothesize that PACs reduce PM2.5 and lower SBP in a sustained fashion among adults with treated and untreated HTN in New York City public housing. To test this hypothesis, we will evaluate whether PACs reduce PM2.5 and SBP over longer, clinically relevant time horizons, and in a larger cohort than studied by other investigators to date. Further, we will evaluate inflammatory cytokines as predictors of SBP response to PACs. Guided by strong preliminary data, this proposal will pursue three specific aims: 1) Determine if PACs lower morning (AM) self-measured home SBP (H-SBP) over 30, 90 and 180 days among 440 adults with treated and untreated HTN living in New York City public housing; 2) Test if adults with HTN and increased adiposity have larger decreases in morning H-SBP with PACs compared to adults with less adiposity; and 3) Determine whether higher baseline inflammatory cytokines predict a greater SBP response to PACs. This proposal is innovative in its use of self-measured home blood pressure, air pollution monitoring, and cytokine measurements in an urban public housing community with excess burdens of obesity and HTN and is significant because it will advance knowledge of whether PACs can be used to reduce PM2.5 exposure— on an individual level—and lower blood pressure, a meaningful health endpoint causally linked to CV disease. Ultimately, such knowledge may provide millions of Americans and populations worldwide with access to a personal strategy to reduce the adverse CV effects of air pollution exposure.

项目摘要空气污染每年导致美国超过 213,000 人超额死亡，在全球范围内仍然是第四大死亡原因此外，大多数与空气污染相关的死亡是由于心血管（CV）疾病造成的。我们和其他人发现，短期空气污染暴露会使收缩压 (SBP) 升高 2- 10 mmHg，而长期接触会促进高血压 (HTN) 的发生——这是一个关键因素空气污染暴露与心血管疾病风险之间的关系然而，支持这一点的证据还存在差距。减少空气污染对心血管的不利影响的个人策略，以及改变公众所需的共识在这一证据差距得到解决之前，空气污染政策仍然难以捉摸。高血压和随后的心血管疾病的潜在可改变但未经治疗的危险因素。我们提案的目标是进行一项关键的临床试验，以测试室内的个人空气净化器 (PAC) 减少细颗粒空气污染的设置 <2.5 µM (PM2.5)——空气中对血管毒性最强的成分污染 - 以及接受治疗和未治疗的高血压的成年人队列中的较低 SBP 来自我们小组和的数据。其他研究表明，PAC 在 3-10 天内将 SBP 降低 3-5 mmHg，SBP 降低幅度更大（约 8mmHg）在肥胖成年人中，这些益处可能是由于炎症细胞因子的减少所致。资源丰富的社区（例如城市公共住房居民）可以同时体验室内和室外空气污染不平等、肥胖和高血压的过度负担，并且面临持续不利健康的高风险 PM2.5 暴露的影响我们勇敢地面对 PAC 可以持续减少 PM2.5 并降低 SBP。为了检验这一假设，我们将在纽约市公共住房中接受治疗和未接受治疗的高血压成年人中进行调查。评估 PAC 是否可以在更长、临床相关的时间范围内、更大范围内降低 PM2.5 和 SBP 此外，我们将评估炎症细胞因子： SBP 对 PAC 反应的预测因素在强有力的初步数据的指导下，该提案将追求三个具体目标。目标：1) 确定 PAC 在 30、90 和 180 天内是否降低早晨 (AM) 自测家庭收缩压 (H-SBP) 对居住在纽约市公共住房的 440 名接受治疗和未接受治疗的 HTN 成年人进行调查 2) 测试是否患有 HTN；与服用较少药物的成年人相比，高血压和肥胖增加使 PAC 组的早晨 H-SBP 下降幅度更大肥胖；和 3) 确定较高的基线炎症细胞因子是否预示着较高的 SBP 反应该提案的创新之处在于使用了自我测量的家庭血压、空气污染监测、肥胖和高血压负担过重的城市公共住房社区的细胞因子测量其意义重大，因为它将增进人们对 PAC 是否可用于减少 PM2.5 暴露的了解—— 在个人层面上——以及降低血压，这是一个与心血管疾病有因果关系的有意义的健康终点。最终，这些知识可能会为数百万美国人和全世界人民提供获取知识的机会。减少空气污染暴露对心血管的不利影响的个人策略。