Fossil-fuel combustion related winter heating has become a major air quality and public health concern in northern China recently. We analyzed the impact of winter heating on aerosol loadings over China using the MODIS-Aqua Collection 6 aerosol product from 2004–2012. Absolute humidity (AH) and planetary boundary layer height (PBL) -adjusted aerosol optical depth (AOD*) was constructed to reflect ground-level PM2.5 concentrations. GIS analysis, standard statistical tests, and statistical modeling indicate that winter heating is an important factor causing increased PM2.5 levels in more than three-quarters of central and eastern China. The heating season AOD* was more than five times higher as the non-heating season AOD*, and the increase in AOD* in the heating areas was greater than in the non-heating areas. Finally, central heating tend to contribute less to air pollution relative to other means of household heating.

According to our survey in Yangbajing, Tibetan adults aged 40 years and older living at high altitudes had high BP and prevalence of hypertension with low awareness, treatment, and control. Future studies are needed to clarify the association between BP, altitude, and other possible causes.

ObjectivesTo evaluate the effects of a low-sodium and high-potassium salt-substitute on lowering blood pressure (BP) among Tibetans living at high altitude (4300 meters).MethodThe study was a patient-blinded randomized controlled trial conducted between February and May 2009 in Dangxiong County, Tibetan Autonomous Region, China. A total of 282 Tibetans aged 40 or older with known hypertension (systolic BP≥140 mmHg) were recruited and randomized to intervention (salt-substitute, 65% sodium chloride, 25% potassium chloride and 10% magnesium sulfate) or control (100% sodium chloride) in a 1: 1 allocation ratio with three months’ supply. Primary outcome was defined as the change in BP levels measured from baseline to followed-up with an automated sphygmomanometer. Per protocol (PP) and intention to treat (ITT) analyses were conducted.ResultsAfter the three months’ intervention period, the net reduction in SBP/DBP in the intervention group in comparison to the control group was −8.2/−3.4 mmHg (all p<0.05) in PP analysis, after adjusting for baseline BP and other variables. ITT analysis showed the net reduction in SBP/DBP at −7.6/−3.5 mmHg with multiple imputations (all p<0.05). Furthermore, the whole distribution of blood pressure showed an overall decline in SBP/DBP and the proportion of patients with BP under control (SBP/DBP<140 mmHg) was significantly higher in salt-substitute group in comparison to the regular salt group (19.2% vs. 8.8%, p = 0.027).ConclusionLow sodium high potassium salt-substitute is effective in lowering both systolic and diastolic blood pressure and offers a simple, low-cost approach for hypertension control among Tibetans in China.Trial RegistrationClinicalTrials.gov NCT01429246