Portable Air Cleaners and Home Systolic Blood Pressure in Adults With Hypertension Living in New York City Public Housing

ypertension is the leading modifiable cardiovascular risk factor globally, 1 with ≈25% of cardiovascular events attributed to hypertension.A large body of evidence supports that exposure to particulate matter air pollution, especially fine particulate matter (PM 2.5 ), increases blood pressure (BP) and promotes hypertension.2 Portable air cleaners (PACs) are an individual-level intervention to decrease air pollution exposure.In our recent meta-analysis, PACs reduced systolic BP by 4 mm Hg over a median of 6 (interquartile range, 2-14) days.3 Studies to date did not use self-measured home BP, a stronger predictor of cardiovascular risk and more accurate estimate of 24-hour BP than office BP. 4 In addition, there is a dearth of evidence on the effects of PACs to reduce air pollution exposure and lower BP specifically in underresourced communities.To address this gap and inform design of future trials, we conducted a randomized, double-blind, shamcontrolled, pilot trial of PACs on self-measured home blood pressure in adults with hypertension living in urban public housing.We hypothesized that continuous bedroom PAC use would reduce self-measured morning (am) home systolic BP (H-SBP) in an urban cohort of adults with hypertension.The data used in this study are available from the corresponding author on reasonable request.We enrolled 20 English-or Spanishspeaking, nonsmoking adults with self-reported hypertension from nonsmoking apartments in New York City public housing.Exclusion criteria included normal BP without antihypertensive medications or an enrollment visit BP >160/100 mm Hg.Participants were randomized in a 1:1 ratio to active versus sham PACs (without high efficiency particulate air filters).PACs were placed in participant bedrooms (or primary sleeping space, if studio apartments).Sham and active units were identical in appearance and sound.This study was approved by the NYU Grossman School of Medicine Institutional Review Board, and all subjects provided informed consent.Participants measured home BP twice each morning, 1 minute apart, following American Heart Association guidelines.Deidentified measurements were transmitted to an online dashboard.A 3-day run-in phase was used to confirm eligibility.PACs were used continuously for 14 days.We used publicly available ambient outdoor PM 2.5 concentration from New York State Department of Environmental Conservation monitoring stations within 1 km of home for background PM 2.5 .Indoor sources of PM 2.