The direct and urinary electrolyte-mediated effects of ambient temperature on population blood pressure: A causal mediation analysis
High ambient heat can directly influence blood pressure (BP) through the vasodilation of the skin vasculature and indirectly by affecting urinary volume and electrolyte levels. We evaluated the direct and urine electrolyte-mediated effects of ambient temperature on BP. We pooled 5,624 person-visit d...
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2025-01-01
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| author | Ayesha Mukhopadhyay Momenul Haque Mondol Mahbubur Rahman Leanne Unicomb Rizwana Khan Hoimonty Mazumder Mohammad Nahian Ferdous Emily V. Pickering Konstantinos C. Makris Alberto J. Caban-Martinez Faruk Ahmed Mohammad Shamsudduha Fawaz Mzayek Chunrong Jia Hongmei Zhang Anwar Musah Lora E. Fleming Matthew P. Smeltzer Howard H. Chang John L. Jefferies Csaba P. Kovesdy Xichen Mou Abu Mohd Naser |
| author_facet | Ayesha Mukhopadhyay Momenul Haque Mondol Mahbubur Rahman Leanne Unicomb Rizwana Khan Hoimonty Mazumder Mohammad Nahian Ferdous Emily V. Pickering Konstantinos C. Makris Alberto J. Caban-Martinez Faruk Ahmed Mohammad Shamsudduha Fawaz Mzayek Chunrong Jia Hongmei Zhang Anwar Musah Lora E. Fleming Matthew P. Smeltzer Howard H. Chang John L. Jefferies Csaba P. Kovesdy Xichen Mou Abu Mohd Naser |
| author_sort | Ayesha Mukhopadhyay |
| collection | DOAJ |
| description | High ambient heat can directly influence blood pressure (BP) through the vasodilation of the skin vasculature and indirectly by affecting urinary volume and electrolyte levels. We evaluated the direct and urine electrolyte-mediated effects of ambient temperature on BP. We pooled 5,624 person-visit data from a community-based stepped-wedge randomized control trial in southwest coastal Bangladesh from December 2016 to May 2017. Same-day ambient temperature data from local weather stations were linked to participant BP and urine electrolytes using geo-locations of their residential addresses. We implemented causal mediation analyses using the product methods of coefficients with linear mixed models under the sequential ignorability assumption. Separate models were run for each urinary electrolyte mediator (sodium, potassium, calcium, and magnesium), followed by combined models to evaluate the natural direct and electrolyte-mediated indirect effects of temperature on BP. Models had participant-level random intercepts and were adjusted for age, sex, body mass index (BMI), religion, exercise, smoking status, sleep hours, alcohol consumption, urine creatinine, time trend, household assets, drinking water salinity, and seasonality. For the combined mediators (sodium, potassium, calcium, and magnesium), for every 5°C increase in average daily temperature: the direct effect on systolic BP was −1.42 (95 % CI: −1.94, −0.92) mmHg and urine sodium mediated effect was −0.12 (95 % CI: −0.20, −0.05) mmHg; while urine potassium mediated effect was 0.15 (95 % CI: 0.08, 0.25) mmHg; urine calcium-mediated effect 0.06 (95 % CI: 0.01, 0.12) mmHg; and urine magnesium mediated effect −0.00 (95 % CI: −0.03, 0.02) mmHg. We detected similar associations for diastolic BP, pulse pressure, and mean arterial pressure. We found a significant inverse direct effect of ambient temperature on BP compared to minimally mediated urine electrolyte effects. Further studies are needed to uncover the underlying mechanisms of ambient heat and BP associations and to describe the clinical consequences of these associations. |
| format | Article |
| id | doaj-art-0f67e23362d14b8793ee5561fec46168 |
| institution | Kabale University |
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| publishDate | 2025-01-01 |
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| spelling | doaj-art-0f67e23362d14b8793ee5561fec461682025-01-24T04:44:04ZengElsevierEnvironment International0160-41202025-01-01195109208The direct and urinary electrolyte-mediated effects of ambient temperature on population blood pressure: A causal mediation analysisAyesha Mukhopadhyay0Momenul Haque Mondol1Mahbubur Rahman2Leanne Unicomb3Rizwana Khan4Hoimonty Mazumder5Mohammad Nahian Ferdous6Emily V. Pickering7Konstantinos C. Makris8Alberto J. Caban-Martinez9Faruk Ahmed10Mohammad Shamsudduha11Fawaz Mzayek12Chunrong Jia13Hongmei Zhang14Anwar Musah15Lora E. Fleming16Matthew P. Smeltzer17Howard H. Chang18John L. Jefferies19Csaba P. Kovesdy20Xichen Mou21Abu Mohd Naser22Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, The University of Memphis, Memphis, TN, USASchool of Population and Public Health, University of British Columbia, Vancouver, BC Canada; Department of Statistics, University of Barishal, Barishal, BangladeshInternational Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka 1212, BangladeshInternational Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka 1212, BangladeshInternational Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka 1212, BangladeshDivision of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, The University of Memphis, Memphis, TN, USADivision of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, The University of Memphis, Memphis, TN, USADivision of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, The University of Memphis, Memphis, TN, USACyprus International Institute for Environmental and Public Health, School of Health Sciences, Cyprus University of Technology, Limassol, CyprusDepartment of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, FL, USADepartment of Engineering Technology, The University of Memphis, Memphis, TN, USADepartment of Risk and Disaster Reduction, University College London, London, UKDivision of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, The University of Memphis, Memphis, TN, USADivision of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, The University of Memphis, Memphis, TN, USADivision of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, The University of Memphis, Memphis, TN, USADepartment of Geography, University College London, London, UKEuropean Centre for Environment and Human Health, University of Exeter Medical School, Penryn, Cornwall, United KingdomDivision of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, The University of Memphis, Memphis, TN, USADepartment of Biostatistics & Bioinformatics, and Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USADivision of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, The University of Memphis, Memphis, TN, USADivision of Nephrology, University of Tennessee Health Science Centre, Memphis, TN, USADivision of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, The University of Memphis, Memphis, TN, USADivision of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, The University of Memphis, Memphis, TN, USA; Corresponding author at: Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, The University of Memphis, Memphis, TN, USA.High ambient heat can directly influence blood pressure (BP) through the vasodilation of the skin vasculature and indirectly by affecting urinary volume and electrolyte levels. We evaluated the direct and urine electrolyte-mediated effects of ambient temperature on BP. We pooled 5,624 person-visit data from a community-based stepped-wedge randomized control trial in southwest coastal Bangladesh from December 2016 to May 2017. Same-day ambient temperature data from local weather stations were linked to participant BP and urine electrolytes using geo-locations of their residential addresses. We implemented causal mediation analyses using the product methods of coefficients with linear mixed models under the sequential ignorability assumption. Separate models were run for each urinary electrolyte mediator (sodium, potassium, calcium, and magnesium), followed by combined models to evaluate the natural direct and electrolyte-mediated indirect effects of temperature on BP. Models had participant-level random intercepts and were adjusted for age, sex, body mass index (BMI), religion, exercise, smoking status, sleep hours, alcohol consumption, urine creatinine, time trend, household assets, drinking water salinity, and seasonality. For the combined mediators (sodium, potassium, calcium, and magnesium), for every 5°C increase in average daily temperature: the direct effect on systolic BP was −1.42 (95 % CI: −1.94, −0.92) mmHg and urine sodium mediated effect was −0.12 (95 % CI: −0.20, −0.05) mmHg; while urine potassium mediated effect was 0.15 (95 % CI: 0.08, 0.25) mmHg; urine calcium-mediated effect 0.06 (95 % CI: 0.01, 0.12) mmHg; and urine magnesium mediated effect −0.00 (95 % CI: −0.03, 0.02) mmHg. We detected similar associations for diastolic BP, pulse pressure, and mean arterial pressure. We found a significant inverse direct effect of ambient temperature on BP compared to minimally mediated urine electrolyte effects. Further studies are needed to uncover the underlying mechanisms of ambient heat and BP associations and to describe the clinical consequences of these associations.http://www.sciencedirect.com/science/article/pii/S0160412024007955Climate ChangeGlobal WarmingEnvironmental HealthAmbient TemperatureBlood PressureNephrology |
| spellingShingle | Ayesha Mukhopadhyay Momenul Haque Mondol Mahbubur Rahman Leanne Unicomb Rizwana Khan Hoimonty Mazumder Mohammad Nahian Ferdous Emily V. Pickering Konstantinos C. Makris Alberto J. Caban-Martinez Faruk Ahmed Mohammad Shamsudduha Fawaz Mzayek Chunrong Jia Hongmei Zhang Anwar Musah Lora E. Fleming Matthew P. Smeltzer Howard H. Chang John L. Jefferies Csaba P. Kovesdy Xichen Mou Abu Mohd Naser The direct and urinary electrolyte-mediated effects of ambient temperature on population blood pressure: A causal mediation analysis Environment International Climate Change Global Warming Environmental Health Ambient Temperature Blood Pressure Nephrology |
| title | The direct and urinary electrolyte-mediated effects of ambient temperature on population blood pressure: A causal mediation analysis |
| title_full | The direct and urinary electrolyte-mediated effects of ambient temperature on population blood pressure: A causal mediation analysis |
| title_fullStr | The direct and urinary electrolyte-mediated effects of ambient temperature on population blood pressure: A causal mediation analysis |
| title_full_unstemmed | The direct and urinary electrolyte-mediated effects of ambient temperature on population blood pressure: A causal mediation analysis |
| title_short | The direct and urinary electrolyte-mediated effects of ambient temperature on population blood pressure: A causal mediation analysis |
| title_sort | direct and urinary electrolyte mediated effects of ambient temperature on population blood pressure a causal mediation analysis |
| topic | Climate Change Global Warming Environmental Health Ambient Temperature Blood Pressure Nephrology |
| url | http://www.sciencedirect.com/science/article/pii/S0160412024007955 |
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