Seasonal variation in blood pressure and its relationship with outdoor air temperature in 10 diverse regions of China: the China Kadoorie Biobank

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1 Seasonal variation in blood pressure and its relationship with outdoor air temperature in diverse regions of China: the China Kadoorie Biobank SUPPLEMENTAL MATERIAL

2 1 Tables etable 1: Seasonal mean outdoor temperature ( C) and diastolic blood pressure (mm Hg) in summer and winter, by area (Footnotes on tables) etable 2: Change (SE) in systolic blood pressure per C fall in outdoor temperature, by various subgroups (in Figure 5) (Footnotes on tables) Figures efigure 1: Locations of the Kadoorie China Biobank recruitment centres efigure 2: Diastolic blood pressure by month of measurement among men and women Mean DBP adjusted for age, sex and area. Only includes months with > participants. The solid circles joined by a solid line indicate months when all ten areas were actively recruiting and the open circles (joined by a dotted line at the beginning and end of the study period) indicate months when only some were active. There is an open circle for tember 27 when Haikou did not recruit due to re-organisation of the survey team. The horizontal placement of each month indicates, for participants recruited in that month, the mean number of days since the first participant was recruited for participants recruited in that month. = January & February combined (recruitment dropped in January & February due to the Chinese New Year).

3 2 efigure 3: Monthly variation in systolic blood pressure by area and sex Mean monthly SBP is the mean for all participants whose baseline survey happened during that month (regardless of the year). SBP means adjusted for age. Winter=ember, January, February; summer=e, y, ust. a In Harbin, % of participants had some form of heating in their home; 94% had central heating. b Areas in which >% of participants had some form of heating in their home. efigure 4: Monthly variation in diastolic blood pressure and outdoor temperature within each area For both DBP and outdoor temperature, the mean monthly values are the mean for all participants whose baseline survey happened during that month (regardless of the year). DBP means adjusted for age and sex. Mean outdoor temperature is indicated by a dotted line (note the inverse scale). a In Harbin, % of participants had some form of heating in their home; 94% had central heating. b Areas in which >% of participants had some form of heating in their home. efigure 5: Mean systolic blood pressure versus outdoor temperature within deciles of relative humidity Mean SBP, but not outdoor temperature, adjusted for age and sex. Relative humidity data not available from Sichuan or Hunan. efigure 6: Mean systolic blood pressure versus relative humidity within deciles of outdoor temperature Mean SBP, but not relative humidity, adjusted for age and sex. Relative humidity data not available from Sichuan or Hunan.

4 3 etable 1: Mean outdoor temperature ( C) and diastolic blood pressure (mm Hg) in summer and winter, by area Latitude & Longitude Summer (e,y,ust) Winter (ember,january,february) Difference (Summer-Winter) Change (SE) in DBP per C lower Area Temperature DBP a Temperature DBP a Temperature DBP a temperature b ( 5 C only) Harbin c 46 N 127 E (.9) Qingdao d 36 N E (.) Suzhou 31 N 121 E (.6) Liuzhou 24 N 9 E (.7) Haikou 2 N 1 E (.14) Urban (.4) Henan d 35 N 114 E (.6) Gansu d 35 N 6 E (.9) Sichuan 31 N 4 E (.7) Zhejiang 31 N 121 E (.6) Hunan d 28 N 114 E (.6) Rural (.3) Overall (.2) a DBP = Diastolic Blood Pressure, adjusted for age, sex and area (where appropriate) b Adjusted for age, sex and area (where appropriate) c 94% have home central heating d >% have home heating

5 4 etable 2: Change (SE) in SBP per C fall in outdoor temperature, by various subgroups (in Figure 4) Absolute difference (mmhg) Percentage difference Change (SE) in SBP per C fall in temp (>=5 C) a Age group (years) (.11) (.8) (.7) (.) (.16) BMI b group (kg/m 2 ) < (.18) 18.5-< (.7) 22.5-< (.7) 25-< (.7) (.2) Smoking, men only c Never (.16) Occasional (.17) Current (.8) Ex-smoker (.16) Alcohol, men only Never (.13) Occasional (.) Current weekly (.11) Ex-drinker (.3) Blood pressure lowering treatment No (.4) Yes (.11) Heating None (.6) Central (.16) Other (.6) Overall (.4) a Adjusted for age, sex and area (where appropriate) b Within the range 15-4 kg/m 2. Body-mass index (BMI) was calculated as weight in kilograms divided by the square of the height in metres c Further adjusted for BMI

6 efigure 1: Locations of the Kadoorie China Biobank recruitment centres 5 Urban Rural Harbin Gansu Sichuan Henan Qingdao Suzhou Zhejiang Hunan Liuzhou Haikou

7 efigure 2: Diastolic blood pressure by month of measurement Month of DBP measurement 6 Mean DBP & 95% CI (mmhg)

8 7 efigure 3: Monthly variation in systolic blood pressure by area and sex Urban Rural Harbin a : 6.3 : 7.1 Henan b : 12.1 : 11.2 Qingdao b : 6.1 : 3.3 Gansu b :.2 : 11.5 Mean SBP & 95% CI (mmhg) Suzhou : 8.2 : 7.5 Liuzhou : 11.1 : 11.2 Sichuan : 9.4 : 8.8 Zhejiang : 16.5 : 15.1 Haikou : 6. : 3.8 Hunan b : 11.3 : 9.8 Month of measurement

9 8 efigure 4: Monthly variation in diastolic blood pressure and outdoor temperature within each area Urban Rural Harbin a Henan b Qingdao b Mean DBP & 95% CI (mmhg) Suzhou Liuzhou Gansu b Sichuan Zhejiang Mean monthly temperature ( o C) 2 3 Haikou Hunan b Month of measurement

10 9 efigure 5: Mean systolic blood pressure versus outdoor temperature within deciles of relative humidity Humidity decile Mean SBP (mmhg) 2 3 Temperature ( C)

11 efigure 6: Mean systolic blood pressure vs. relative humidity within deciles of outdoor temperature Temperature decile Mean SBP (mmhg) Relative humidity (%)

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