Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2022 Jun 15:303:119109.
doi: 10.1016/j.envpol.2022.119109. Epub 2022 Mar 8.

Effects of respirators to reduce fine particulate matter exposures on blood pressure and heart rate variability: A systematic review and meta-analysis

Sasan Faridi  1 , Robert D Brook  2 , Fatemeh Yousefian  3 , Mohammad Sadegh Hassanvand  4 , Ramin Nabizadeh Nodehi  4 , Mansour Shamsipour  5 , Sanjay Rajagopalan  6 , Kazem Naddafi  7
Affiliations
Meta-Analysis

Effects of respirators to reduce fine particulate matter exposures on blood pressure and heart rate variability: A systematic review and meta-analysis

Sasan Faridi et al. Environ Pollut. .

Abstract

Particulate-filtering respirators (PFRs) have been recommended as a practical personal-level intervention to protect individuals from the health effects of particulate matter exposure. However, the cardiovascular benefits of PFRs including improvements in key surrogate endpoints remain unclear. We performed a systematic review and meta-analysis of randomized studies (wearing versus not wearing PFRs) reporting the effects on blood pressure (BP) and heart rate variability (HRV). The search was performed on January 3, 2022 to identify published papers until this date. We queried three English databases, including PubMed, Web of Science Core Collection and Scopus. Of 527 articles identified, eight trials enrolling 312 participants (mean age ± standard deviation: 36 ± 19.8; 132 female) met our inclusion criteria for analyses. Study participants wore PFRs from 2 to 48 h during intervention periods. Wearing PFRs was associated with a non-significant pooled mean difference of -0.78 mmHg (95% confidence interval [CI]: -2.06, 0.50) and -0.49 mmHg (95%CI: -1.37, 0.38) in systolic and diastolic BP (SBP and DBP). There was a marginally significant reduction of mean arterial pressure (MAP) by nearly 1.1 mmHg (95%CI: -2.13, 0.01). The use of PFRs was associated with a significant increase of 38.92 ms2 (95%CI: 1.07, 76.77) in pooled mean high frequency (power in the high frequency band (0.15-0.4 Hz)) and a reduction in the low (power in the low frequency band (0.04-0.15Hz))-to-high frequency ratio [-0.14 (95%CI: -0.27, 0.00)]. Other HRV indices were not significantly changed. Our meta-analysis demonstrates modest or non-significant improvements in BP and many HRV parameters from wearing PFRs over brief periods. However, these findings are limited by the small number of trials as well as variations in experimental designs and durations. Given the mounting global public health threat posed by air pollution, larger-scale trials are warranted to elucidate more conclusively the potential health benefits of PFRs.

Keywords: Air pollution; Blood pressure; Heart rate variability; Particulate-filtering respirators.

PubMed Disclaimer

Conflict of interest statement

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1.
Fig. 1.
Flowchart illustrating the stages of the literature search.
Fig. 2.
Fig. 2.
Meta-analysis of the effects of wearing PFR on BP. The mean difference estimates (95%CIs) are shown for SBP (A), DBP (B) and MAP (C).
Fig. 3.
Fig. 3.
Meta-analysis of the effects of wearing PFR on HRV indices. The mean difference estimates (95%CIs) are shown for HF (A), LF (B), LF:HF ratio (C), SDNN (D), rMSSD (E), pNN50 (F) and HR (G).
Fig. 3.
Fig. 3.
Meta-analysis of the effects of wearing PFR on HRV indices. The mean difference estimates (95%CIs) are shown for HF (A), LF (B), LF:HF ratio (C), SDNN (D), rMSSD (E), pNN50 (F) and HR (G).
See this image and copyright information in PMC

References

    1. Adler A, Agodoa L, Algra A, Asselbergs FW, Beckett NS, Berge E, Black H, Brouwers FP, Brown M, Bulpitt CJ, 2021. Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis. Lancet 397, 1625–1636. - PMC - PubMed
    1. Al-Kindi SG, Brook RD, Biswal S, Rajagopalan S, 2020. Environmental determinants of cardiovascular disease: lessons learned from air pollution. Nat. Rev. Cardiol. 17, 656–672. - PMC - PubMed
    1. Allen RW, Barn P, 2020. Individual-and household-level interventions to reduce air pollution exposures and health risks: a review of the recent literature. Curr. Environ. Health Rep. 1–17. - PMC - PubMed
    1. Bard RL, Ijaz MK, Zhang JJ, Li Y, Bai C, Yang Y, Garcia WD, Creek J, Brook RD, 2019. Interventions to reduce personal exposures to air pollution: a primer for health care providers. Global Heart 14, 47–60. - PubMed
    1. Basu R, Malig B, Broadwin R, Ebisu K, Gold EB, Qi L, Derby C, Green RS, 2017. Association between gaseous air pollutants and inflammatory, hemostatic and lipid markers in a cohort of midlife women. Environ. Int. 107, 131–139. - PMC - PubMed

Substances