Ambulatory monitoring demonstrates an acute association between cookstove-related carbon monoxide and blood pressure in a Ghanaian cohort.

Authors:
Ashlinn K Quinn
Ashlinn K Quinn
Mailman School of Public Health
New York | United States
Patrick L Kinney
Patrick L Kinney
Columbia University
United States
Dr. Seyram Kaali, MD, MPH
Dr. Seyram Kaali, MD, MPH
Kintampo Health Research Centre
Kintampo, Brong-Ahafo Region | Ghana
Blair J Wylie
Blair J Wylie
Massachusetts General Hospital and Harvard Medical School
Boston | United States
Daichi Shimbo
Daichi Shimbo
Columbia University Medical Center
New York | United States
Oscar Agyei
Oscar Agyei
Kintampo Health Research Centre

Environ Health 2017 07 21;16(1):76. Epub 2017 Jul 21.

Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana.

Background: Repeated exposure to household air pollution may intermittently raise blood pressure (BP) and affect cardiovascular outcomes. We investigated whether hourly carbon monoxide (CO) exposures were associated with acute increases in ambulatory blood pressure (ABP); and secondarily, if switching to an improved cookstove was associated with BP changes. We also evaluated the feasibility of using 24-h ambulatory blood pressure monitoring (ABPM) in a cohort of pregnant women in Ghana.

Methods: Participants were 44 women enrolled in the Ghana Randomized Air Pollution and Health Study (GRAPHS). For 27 of the women, BP was measured using 24-h ABPM; home blood pressure monitoring (HBPM) was used to measure BP in the remaining 17 women. Personal CO exposure monitoring was conducted alongside the BP monitoring.

Results: ABPM revealed that peak CO exposure (defined as ≥4.1 ppm) in the 2 hours prior to BP measurement was associated with elevations in hourly systolic BP (4.3 mmHg [95% CI: 1.1, 7.4]) and diastolic BP (4.5 mmHg [95% CI: 1.9, 7.2]), as compared to BP following lower CO exposures. Women receiving improved cookstoves had lower post-intervention SBP (within-subject change in SBP of -2.1 mmHg [95% CI: -6.6, 2.4] as compared to control), though this result did not reach statistical significance. 98.1% of expected 24-h ABPM sessions were successfully completed, with 92.5% of them valid according to internationally defined criteria.

Conclusions: We demonstrate an association between acute exposure to carbon monoxide and transient increases in BP in a West African setting. ABPM shows promise as an outcome measure for assessing cardiovascular health benefits of cookstove interventions.

Trial Registration: The GRAPHS trial was registered with clinicaltrials.gov on 13 April 2011 with the identifier NCT01335490 .

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http://dx.doi.org/10.1186/s12940-017-0282-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5521137PMC

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July 2017
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