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Temporal trends and geographical variations in cardiovascular disease attributable to high systolic blood pressure in China are not yet fully understood. The aim of this study was to quantify the cardiovascular disease burden attributable to high systolic blood pressure at national and provincial levels in China.In this population-based study, we evaluated systolic blood pressure and estimated the number of deaths, age-standardised mortality rates, and years of life lost (YLLs) due to cardiovascular disease and its subcategories (including ischaemic heart disease, ischaemic stroke, haemorrhagic stroke, and other cardiovascular diseases) attributable to high systolic blood pressure, at the national level and by 31 provincial levels, in China, from 2005 to 2018. We pooled blood pressure data of 1·30 million adults aged 25 years and older from the China Chronic Disease and Risk Factor Surveillance project, the China National Nutrition Survey, and the China Hypertension Survey. We applied a temporal-spatial Bayesian hierarchical model to estimate age-specific, sex-specific, province-specific, and year-specific average systolic blood pressure, and a comparative risk assessment method to compute the cardiovascular disease burden attributable to high systolic blood pressure by age, sex, year, and province.Nationally, age-standardised mean systolic blood pressure was 132·5 mm Hg (95% uncertainty interval [UI] 124·6-140·3) in men and 129·4 mm Hg (121·7 to 137·2) in women. 2·67 million (95% UI 2·61 to 2·72) cardiovascular disease deaths in China were attributable to high systolic blood pressure, including 1·12 million deaths (1·07 to 1·16) due to ischaemic heart disease, 0·63 million deaths (0·60 to 0·65) due to ischaemic stroke, 0·58 million deaths (0·57 to 0·60) due to haemorrhagic stroke, and 0·34 million deaths (0·32 to 0·36) due to other cardiovascular disease. The age-standardised cardiovascular disease mortality rates associated with high systolic blood pressure were 268·99 per 100 000 people (95% UI 264·11 to 273·51) in 2005 and 220·84 per 100 000 people (216·30 to 224·76) in 2018, a percentage change of -17·90%; the rate changed by an average of -1·50% (95% UI -1·55% to -1·45%) per year from 2005 to 2018 nationally. YLL rates for total cardiovascular disease caused by high systolic blood pressure varied substantially across provinces, ranging from 3078·33 (95% UI 2807·40 to 3303·57) per 100 000 people in Beijing to 7189·98 (95% UI 6817·18 to 7507·99) per 100 000 people in Heilongjiang in 2018. Age-standardised YLL rates for ischaemic heart disease and ischaemic stroke attributable to high systolic blood pressure were particularly high in northeastern provinces, including Heilongjiang, Liaoning, and Jilin.The deaths and YLLs for cardiovascular disease attributable to high systolic blood pressure in China increased between 2005 and 2018, and age-standardised cardiovascular disease mortality rates decreased in the same timeframe. Our findings could help policy makers in promoting blood pressure control measures and implementing effective and locally adapted preventive interventions to reduce the prevalence of high systolic blood pressure and reduce the burden of systolic blood pressure-related cardiovascular disease in China.China National Key Research and Development Program, China National ScienceTechnology Pillar Program, and National Health Commission of the People's Republic of China.For the Chinese translation of the abstract see Supplementary Materials section.

Jia Kang,1,* Guangqi Li,1,* Miao Ma,2 Min Lan,3 Yuting Kang,4 Ningai Yang,4 Wei Jia,1,4 Zhijun Zhao1,4 1Medical Experimental Center, General Hospital of Ningxia Medical University, Yinchuan, People’s Republic of China; 2Clinical Laboratory Center, Shaanxi Provincial People’s Hospital, Xi’an, People’s Republic of China; 3School of Clinical Medicine, Ningxia Medical University, Yinchuan, People’s Republic of China; 4Ningxia Key Laboratory of Clinical and Pathogenic Microbiology, General Hospital of Ningxia Medical University, Yinchuan, People’s Republic of China*These authors contributed equally to this workCorrespondence: Wei Jia; Zhijun Zhao, Medical Experimental Center, General Hospital of Ningxia Medical University, Yinchuan, 750001, People’s Republic of China, Tel +86 951-6743543, Email Jiawei220803@163.com; zhaozhijun@nxmu.edu.comPurpose: Carbapenem-resistant Klebsiella pneumoniae (CR-KP) has emerged as an important public health threat. Intestinal colonization with CR-KP increases the risk of infection and death, especially in intensive care unit patients. To clarify the source of colonizing bacteria is very important to prevent the spread of CR-KP, so the purpose of this study was to explore the relationship between the ward environment and intestinal colonization of CR-KP.Methods: In this study, 353 environmental swabs from ICU (Intensive Care Unit) wards and 241 anal swab samples from ICU patients were collected and screened on MacConkey plates containing 2 μg/mL ertapenem, and the origin and genotype of CR-KP were analyzed by PCR and sequencing. The sequence type of the strains was also obtained by multi-locus sequence type (MLST) analysis, and plasmid conjugation test was used to clarify whether CR-KP can promote the transmission of drug resistance genes through plasmid integration and rearrangement.Results: A total of 20 CR-KP environmental strains and 7 intestinal strains were obtained, most of which were blaOXA-48 resistant genotypes. Four different STs were identified by multi-locus sequence type (MLST) analysis, among which the large logarithm was ST485 type, and PFGE clustering showed that the similarity between them was > 85%. In the plasmid transcoupling assay, we report that one of the Klebsiella pneumoniae drug-resistant plasmids was successfully transferred to E. coli, indicating that it may promote the spread of drug-resistant genes through plasmid integration and rearrangement.Conclusion: Our research suggests that the environment may be a potential source of CR-KP and that there is a need for us to adopt more effective disinfection measures.Keywords: carbapenem-resistant Klebsiella, intestinal, colonization, environment, ICU, homology

Hypertension is a major health burden worldwide. However, there is limited data on the status of hypertension-mediated organ damage (HMOD) and established cardiovascular (CV) disease in Chinese hypertensive patients. The aim of this study is to determine the prevalence of HMOD and established CV disease in a nationally representative population in China. A stratified multistage random sampling method was used in the China Hypertension Survey and 21,243 participants aged 35 or older were eligible for analysis in this study. For each participant, the demographic information and a self-reported medical history were acquired. Blood pressure was measured with the electronic device 3 times on the right arm, supported at heart level, after the participant was sitting at rest for 5 min. Samples of blood and urine were tested. 2-D and Doppler echocardiography were used to assess the heart’s function and structures. Sampling weights were calculated based on the 2010 China population census data. Overall, the weighted prevalence of asymptomatic HMOD was 22.1%, 28.9%, 23.1%, 6.4%, and 6.2% for wide pulse pressure, left ventricular hypertrophy, microalbuminuria, chronic kidney disease, and abnormal ankle-brachial index, respectively. For the established CV disease, the weighted prevalence was 1.8%, 1.3%, 2.0%, and 1.1% for stroke, coronary artery disease, heart failure, and atrial fibrillation, respectively. The prevalence of asymptomatic HMOD and established CV disease was greater with higher blood pressure level (P

The phenyl content is an important quality parameter for phenyl silicone oils, yet its current determination method by 1H NMR is still unsatisfactory due to the potential interference of methylphenylcyclosiloxane or solvents such as toluene and xylene. Herein, a novel method has been developed for the determination of the phenyl content in phenyl silicone oils by gel permeation chromatography-ultraviolet detection (GPC-UV) analysis. Under optimized parameters, the standard curve has been established in the linear range of 5-1000 µg/mL with a squared correlation coefficient of more than 0.999, and a quantification limit of 0.972 µg/mL. The GPC-UV method can easily exclude potential interfering substances, such as methylphenyl cyclosiloxane, toluene or xylene, and various silicone oils. The phenyl content in 9 available phenyl silicone oil samples was determined with a recovery in the range of 84.63%-106.74%. The determined phenyl content of sample H1 by GPC-UV was in good agreement with that (0.603 mg/g) by the 1H-NMR analysis.

Polycarboxylic acids (PACs) are important metabolic products in almost all living bodies, yet current analytical methods for detection of PACs in tea beverages are still unsatisfactory due to the complex matrix and physicochemical properties of PACs. In this work, a rapid method was developed for the simultaneous determination of 7 PACs, including tartaric acid, α-ketoglutaric acid, malic acid, malonic acid, cis-aconitic acid, succinic acid, and fumaric acid, in beverages, based on selective removal of the matrix in combination with liquid chromatography–mass spectrometry (LC-MS) analysis. By stirring with activated carbon and the Na2CO3 solution, the matrix in beverages was selectively removed, and PACs were almost retained in the supernatant of diluted Na2CO3 solution. Under optimized parameters, the limit of quantitation for the PACs was in the range of 1–50 ng/mL, and the content of the PACs in 8 beverages was determined with the recovery range of 72.2%–122.5%. The contents of malic acid, malonic acid, and succinic acid in tea beverages were found to be greater than those in non-tea beverages. Moreover, the concentration of these PACs in beverages was found to be multiplied many times in their deterioration period, especially for fumaric acid and α-ketoglutaric acid. These results indicated that PACs can be selected as a criterion to differentiate qualified tea beverages from spoiled beverages.

This study explored the association between age at menarche and the risk of hypertension in Chinese women. A total of 234 867 women aged ≥18 years from the China Hypertension Survey were included in this study. Participants were required to complete a standard questionnaire. Blood pressure and physical examination of the participants were performed by trained medical staff. Spearman correlation analysis was used to explore the correlation between age at menarche and other individual characteristics. Logistic regression was used to estimate the odds ratios for hypertension by age in years at menarche. The average age at menarche in Chinese women was 14.8 years. Women who were older at menarche were more likely to have a higher body mass index, larger waist circumference, smoke, and have a primary education (p

The purpose of this study was to assess the association of blood pressure (BP) measurements with the risk of cardiovascular disease (CVD) and examine whether central systolic BP (CSBP) predicts CVD better than brachial BP measurements (SBP and pulse pressure [PP]). Based on a cross-sectional study conducted in 2009-2010 with follow-up in 2016-2017 among 35- to 64-year-old subjects in China, we evaluated the performance of non-invasively predicted CSBP over brachial BP measurements on the first CVD events. Each BP measurement, individually and jointly with another BP measurement, was entered into the multivariate Cox proportional-hazards models, to examine the predictability of central and brachial BP measurements. Mean age of participants (n = 8710) was 50.1 years at baseline. After a median follow-up of 6.36 years, 187 CVD events occurred. CSBP was a stronger predictor for CVD than brachial BP measurements (CSBP, 1-standard deviation increment HR = 1.49, 95%CI: 1.31-1.70). With CSBP and SBP entering into models jointly, the HR for CSBP and SBP was 1.28 (1.04-1.58) and 1.22 (0.98-1.50), respectively. With CSBP and PP entering into models jointly, the HR for CSBP and PP was 1.51 (1.28-1.78) and 0.98 (0.83-1.15), respectively. For subgroup analysis, the association of CSBP with CVD was stronger than brachial BP measurements in women, those with hypertension and obesity. In the middle-aged Chinese population, noninvasively estimated CSBP may offer advantages over brachial BP measurements to predict CVD events, especially for participants with higher risk. These findings suggest prospective assessment of CSBP as a prevention and treatment target in further trials.

Although previous studies indicated that the left ventricular diastolic dysfunction (LVDD) is associated with cardiovascular disease (CVD), it remains unclear whether effects would be enhanced or accelerated by long-term air pollution exposure. During 4.65 years (107,726 person-years) of follow-up, 942 cases of CVD events incident were identified among 23,143 participants from the China Hypertension Survey (CHS). Grading diastolic dysfunction was based on Recommendations for the evaluation of left ventricular diastolic function by echocardiography (2009). The annual average PM

Background Although numerous studies have been published evaluating the positive or negative effects of altitude on cardiovascular disease, many of them are conflicting. Methods and Results Data come from 2 cross‐sectional surveys using a similar method in China; and a total of 34 215 residents, aged ≥35 years, were eligible and recruited in the study. Left ventricular diastolic dysfunction (LVDD), according to the 2009 American Society of Echocardiography guidelines, was defined and evaluated. Altitude was divided into low (P trend P interaction =0.0019). Conclusions Higher altitude is associated with increased risk of LVDD among people living over 1500 m, especially for men.

Background The epidemiology of valvular heart disease (VHD) has changed markedly over the last 50 years worldwide, and the prevalence and features of VHD in China are unknown. The objective of this study was to investigate the current status and etiology of VHD in China. Methods We used a cross-sectional national survey with stratified multistage random sampling from the general Chinese population to estimate the VHD burden. Data on demographic characteristics, medical history, physical examination, blood tests, and potential etiology were collected. Echocardiography was used to detect VHD. Results The national survey enrolled 34,994 people aged 35 years or older across China. Overall, 31,499 people were included in the final analysis, and 1309 participants were diagnosed with VHD. The weighted prevalence was 3.8%, with an estimated 25 million patients in China. The prevalence of VHD increased with age and was higher in participants with hypertension or chronic kidney disease than in their counterparts. Among participants with VHD, 55.1% were rheumatic and 21.3% were degenerative. The proportion of rheumatic decreased with age, and the proportion of degenerative rose with age. However, the prevalence of rheumatic disease was still higher in the elderly population than in the younger population. Logistic regression revealed that age and hypertension were correlated with VHD. Conclusions In China, rheumatic heart disease was still the major cause of the VHD, with a significant increase in degenerative heart disease. Age and hypertension are important and easily identifiable markers of VHD.

In the context of global climate change, far less is known about the impact of long-term temperature variability (TV), especially in developing countries. The current study aimed to estimate the effect of long-term TV on the incidence of cardiovascular disease (CVD) in China. A total of 23,721 individuals with a mean age of 56.15 years were enrolled at baseline from 2012 to 2016 and followed up during 2017–2019. TV was defined as the standard deviation of daily temperatures during survey years and was categorized into tertiles (lowest≤ 8.78 °C, middle = 8.78–10.07 °C, highest ≥ 10.07 °C). The Cox proportional hazards regression was used to estimate the multivariable-adjusted hazard ratio (HR) between TV and CVD. During the median follow-up of 4.65 years, we ascertained 836 cases of incident CVD. For per 1 °C increase in TV, there was a 6% increase of CVD (HR = 1.06 [95% confidence interval (CI): 1.01–1.11]). A significant positive trend was observed between CVD risk and increasing levels of TV compared to the lowest tertile [HR = 1.34 (95% CI: 1.13–1.59) for the medium tertile, HR = 1.72 (95% CI: 1.35–2.19) for the highest tertile, Ptrend

To explore the association between unbalanced social determinants status and hypertension (HTN) in China, we conducted a cross‐sectional survey in a sample of 299 220 Chinese in 2012 to 2015. Social determinants status were measured with: (a) district‐level:Per capita GDP (Per_GDP), the number of hospital beds per 1000 residents (Per 1000_bed) and tertiary industry added value (TIAV); (b) individual‐level: education and employment conditions. Compared with the poorest level of Per_GDP, the middle and richest group had higher risk of HTN [OR, 95%CI: 1.12 (1.09‐1.14) and 0.99 (0.96‐1.02)] and higher possibility of HTN awareness, treatment, and control. Higher risk of HTN and lower possibility of awareness, treatment, and control were associated with elevated Per 1000_bed in rural area. Higher possibility of HTN control was associated with the higher TIAV (P (trend)

IMPORTANCE: A workplace-based intervention could be an effective approach to managing high blood pressure (BP). However, few studies to date have addressed hypertension control among the Chinese working population. OBJECTIVE: To assess the effect of a workplace-based, multicomponent intervention strategy on improving BP control. DESIGN, SETTING, AND PARTICIPANTS: A cluster randomized clinical trial of a hypertension management program was conducted from January 2013 to December 2014 in 60 workplaces across 20 urban regions in China. Workplaces were randomized to either the intervention group (n = 40) or control group (n = 20). Employee participants in each workplace were asked to complete a cross-sectional survey. Data analysis on an evaluable population was conducted from January 2016 to January 2017. INTERVENTIONS: The 2-year intervention included 2 components: (1) a workplace wellness program for improving employees’ cardiovascular health and (2) a guidelines-oriented hypertension management protocol with a community health center intervention accompanied by monthly visits for achieving BP control over a period of 24 months. MAIN OUTCOMES AND MEASURES: The primary outcome was the change in BP control rate from baseline to 24 months among employees with hypertension in the intervention and control groups. The secondary outcomes were the changes in BP level and lifestyle factors by the end of the trial. RESULTS: Overall, 4166 participants (3178 in the intervention group and 988 in the control group) were included (mean [SD] age, 46.3 [7.6] years; 3451 men [82.8%]). Blood pressure control rate at baseline was 19.5% in the intervention group and 20.1% in the control group. After 24 months of the intervention, the BP control rate for the intervention group compared with the control group was significantly higher (66.2% vs 44.0%; odds ratio, 1.77; 95% CI, 1.58-2.00; P

To explore the relationship of color vision deficiency with myopia progression and axial elongation in Chinese primary school children during a five-year cohort study.A total of 2849 grade 1 students (aged 7.1 ± 0.4 years) from 11 primary schools were enrolled and followed up for five years. Cycloplegic autorefraction and axial length were measured annually. Color vision testing was performed using Ishihara's test and the City University color vision test.The prevalence of color vision deficiency was 1.68%, with 2.81% in boys and 0.16% in girls. Color-deficient cases consisted of 91.6% deutan and 8.3% protan. Over the five years, the cumulative incidence of myopia was 35.4% (17/48) in the color-vision deficiency group, which was lower than the 56.7% (1017/1794) in the color normal group (P = 0.004). Over the five-year study period, the change in spherical equivalent refraction in the color vision-deficiency group (-1.81 D) was also significantly lower than that in the color normal group (-2.41 D) (P = 0.002).The lower incidence and slower progression of myopia in children with color-vision deficiency over the five-year follow-up period suggest that color-deficient individuals are less susceptible to myopia onset and development.

Only a few prospective studies have investigated the relationship between solid fuel use and cardiovascular disease (CVD) and mortality, and they have reported inconsistent conclusions. This study aimed to investigate the effect of solid fuel heating on the risk of CVD events and all-cause mortality among non-smokers. Data of this sub-study were obtained from the China Hypertension Survey (CHS), and 13,528 non-smoking participants aged 35 or above without self-reported medical history of CVD were enrolled between October 2012 and December 2015. CVD events and all-cause mortality were followed up in 2018 and 2019. The type of primary heating fuel was categorized as clean fuel (natural gas and electricity) and solid fuel (coal, wood, and straw). Cox regression was applied to evaluate the relationship between solid fuel use and CVD events and all-cause mortality. Of the 13,528 non-smoking participants, the mean age was 55.4 ± 13.1 years. During the median follow-up of 4.93 years, 424 participants developed fatal or nonfatal CVD (stroke, 273; coronary heart disease, 119; and other cardiovascular events, 32) and 288 died from all causes. The cumulative incidence of fatal and nonfatal CVD and all-cause mortality were 6.78 and 4.62 per 1000 person-years, respectively. Solid fuel heating was independently associated with an increased risk of fatal or nonfatal stroke and all-cause mortality compared with the use of clean fuels, the fully adjusted hazard ratios (HRs), and 95% confidence intervals (CI) were 1.44 (1.00–2.08) and 1.55 (1.10–2.17), respectively. The relationship between solid fuel heating and fatal and nonfatal CVD events was non-significant (HR = 1.19; 95% CI: 0.89–1.59). Solid fuel heating is longitudinally associated with a higher risk of stroke and all-cause mortality in non-smoking Chinese. Switching to cleaner energy sources for heating may be important for reducing the risk of CVD and mortality.

Background The epidemiological data on the use of aspirin in diabetic patients is very limited. The main purpose of this study is to examine the current status of aspirin use in the United States (US) and China in large representative populations. Methods Data came from the National Health and Nutrition Examination Survey (NHANES) and China Hypertension Survey (CHS), two nationally representative cross-sectional studies. Results The percentage of aspirin use was 73.8% in US diabetic patients with ASCVD, and the percentage of aspirin use in diabetic patients with high ASCVD risk was marginally higher in men ( p = .052), 54.5% in men and 37.1% in women. The percentages of aspirin use in diabetic patients with intermediate and low ASCVD risk were 55.1% and 35.0%, respectively. In China, the percentage of aspirin use in diabetic patients with ASCVD was 53.5%, and were 14.3%, 9.7%, and 3.2% among diabetic patients with high, intermediate, and low ASCVD risk, respectively. Conclusions In summary, the percentage of aspirin use in primary prevention in US diabetic patients in men was higher than in women, and this percentage for primary and secondary prevention in US patients was higher than that in Chinese patients.

Background: In 2017, the American College of Cardiology (ACC) and the American Heart Association (AHA) published guidelines on the diagnosis and treatment of high BP (blood pressure) in adults. The impact of clinic outcome and economy need to be estimated for adopting the guidelines in China. Methods: Data from a nationally representative sample in China were analyzed. The prevalence and treatment were calculated based on the criteria of the 2017 ACC/AHA and 2010 Chinese guidelines among participants aged ≥35 years old. Direct medical costs, as well as the averted disability adjusted of life years (DALYs) and cost saving from cardiovascular disease (CVD) events prevented by controlling hypertension, were also estimated. Results: The prevalence and treatment rate of hypertension was 32.0% and 43.4% according to the 2010 Chinese guidelines. Based on the 2017 ACC/AHA guidelines, another 24.5% of the adult population (estimated 168.1 million) would be classified with hypertension; of which about 32.1 million hypertensive patients would need to be pharmaceutically treated to reach the current treatment rate of 43.4% ( Table 1 ). As a result, an additional 288.1 billion Chinese currency Renminbi (RMB) of direct medical cost will be required for the lifetime. The new guidelines would reduce lifetime costs by 22.77 billion RMB, while preventing 1,292,881 DALYs lost due to CVD events ( Table 2 ). Conclusions: Application of the 2017 AHA/ACC guidelines in China will substantially increase the prevalence of hypertension and produce a large increase of therapy costs, although it would prevent CVD events and save DALYs. The newly released 2018 Chinese Blood Pressure Management Guidelines defined normal BP as systemic BP

BACKGROUND Heart failure (HF) is a major health burden worldwide. However, there is no nationwide epidemiological data on HF in China after 2000. The aims of this study are (i) to determine the prevalence of left ventricular (LV) dysfunction and HF (with reduced, mid-range, and preserved ejection fraction) in a nationally representative Chinese population, and (ii) to investigate the treatment and control of hypertension in HF patients. METHODS AND RESULTS Data from the China Hypertension Survey (CHS) and 22 158 participants were eligible for analysis in this study. For each participant, a self-reported history of HF and any other cardiovascular diseases was acquired. Two-dimensional and Doppler echocardiography was used to assess LV dysfunction. Overall, 1.3% (estimated 13.7 million) of the Chinese adult population aged ≥35 years had HF, 1.4% of participants had LV systolic dysfunction (ejection fraction

Background Data regarding the metabolic risk factors clustering on the risk of left ventricular diastolic dysfunction ( LVDD ) are lacking among people living at high altitude and under hypoxic conditions. In this study, we explored the association between metabolic risk factor clustering and LVDD among the Tibetan population of China. Methods and Results We conducted a cross‐sectional survey in a representative sample of 1963 Tibetans in 2014 to 2016. Grading LVDD was based on recommendations for the evaluation of LV diastolic function by echocardiography (2009). The prevalence of LVDD among 1963 participants (mean age: 51.51 years, 41.11% male) was 34.39%. Odds ratios (95% CI ) of LVDD for the 1, 2, and 3 to 5 risk factors clustering were 1.45 (0.96–2.17), 2.68 (1.8–3.98), and 2.9 (1.9–4.43), respectively ( P for trend LVDD was much more pronounced in the middle‐aged group than in the elderly ( P for interaction=0.0170). High altitude was one of the major independent risk factors for LVDD ; however, habitation altitude had no significant effect on the association between metabolic risk factors and LVDD ( P for interaction=0.1022). The multivariable dominance analysis indicated that abdominal obesity, hypertension, and elevated blood glucose were the significant contributors to LVDD . Conclusions There was a significant positive association between the metabolic risk factor clustering number and LVDD among a population living at high altitude, especially in middle‐aged adults. However, habitation altitude itself has no significant effect on the association between metabolic risk factors and LVDD .

Although short-term exposure to fine particulate matter (PM2.5) air pollution has been shown to induce elevated blood pressure (BP), limited evidence is available regarding the association between ambient PM2.5 and BP levels in nationwide China and how the association may change. This study sought to explore acute BP changes with exposure to PM2.5 at levels below China’s current National Ambient Air Quality Standards (NAAQS). Based on a spatiotemporal study of over 1 million adults, we linked BP measurements to daily estimates of PM2.5 from multiple sources (i.e. in situ observations, satellite measurements of aerosol and numeric simulations of air quality model) after adjusting for several individual-level covariates and further conduced the below-criteria models by restricting the analyses within subsets of individuals with short-term PM2.5 exposure below 75 μg m−3 (i.e. NAAQS of 24 h PM2.5 in China). We further explored variations in BP-PM2.5 associations by pollution level and for different demographic groups. With full adjustments, a 10 μg m−3 increase in PM2.5 was statistically significantly associated with a 0.049 mmHg (95% confidence interval, CI: 0.041, 0.057) increase in systolic BP, a 0.022 mmHg (95% CI: 0.017, 0.027) increase in diastolic BP and a 0.77% (95% CI: 0.62%, 0.92%) increased risk of hypertension (HPN). For both BP and HPN, the exposure-response curves were linear, with no threshold effects, at the low-concentration ends and sublinear at the high-concentration ends. Below the current NAAQS, the associations in population level remained statistically significant and were even stronger. A 10 μg m−3 increase in below-NAAQS PM2.5 was associated with a 1.95% (95% CI: 1.44%, 2.47%) increased risk of HPN. Specific subpopulations were more susceptible to PM2.5 exposure. These findings can help support decisions by policymakers to revise related environmental regulations to protect public health.

The reliablel2–l∞andH∞control for a class of Lipschitz nonlinear discrete-time singular systems with time delay is investigated via dynamic feedback control. The main goal of this paper is to design a generalized nonlinear controller such that, for possible actuator failures, the closed-loop system is regular, casual, and stable with a givenl2–l∞andH∞disturbance attenuation level being satisfied. Some sufficient conditions are obtained in terms of linear matrix inequalities (LMIs), and the controller design method is also proposed. Finally, a numerical example is included to illustrate the effectiveness of our proposed results.