Air Pollution and Cardiovascular Disease in Qatar: an Interventional Study to Reduce Blood Pressure

Inclusion Criteria:

• Non-smokers (100% abstinence from use of any smoking or vaping product during theprior year)

• Age ≥18 and less than 60 years old

• Living in a single residence (home, apartment) located anywhere in Qatar

• Mild systolic hypertension: screening visit systolic BP 130 to 159 mm Hg (offtreatment or taking ≤ 2 BP medications that have been stable without changes duringprior 4 weeks) plus ≥ 2 more additional criteria for the metabolic syndrome:

• Waist circumference ≥102 cm if male and ≥88 cm if female

• Fasting triglycerides ≥150 mg/dL (or taking a triglyceride-lowering medication)

• HDL-C ≤ 40 mg/dL if male and ≤ 50 mg/dL if female (or taking an HDL-raisingmedication),

• Fasting glucose ≥100 mg/dL

Exclusion Criteria:

• Pregnancy (self-reported)

• Screening visit urine positive for cotinine (NicAlert >100 ng/mL)

• Living with an active smoker who smokes indoors (by self-report)

• High risk conditions that prohibit allowing home BP to be >130/80 mm Hg duringthe10-week trial including any cardiovascular disease (coronary artery disease,prior stroke, heart failure, peripheral arterial disease, aneurysm) or ≥ stage 3kidney disease (estimated glomerular filtration rate < 60 ml/min)

• A medical condition placing the participant at risk from participation (perinvestigators)

• Expected overnight travel outside their residence during the study

• HEPA filter within the air conditioners of the residence (self-reported) orindividual use of HEPA filter

• Unable to comprehend/sign an informed consent

• Lung disease requiring oxygen

• Cancer receiving treatment

• Screening visit: BP ≥160/100 mm Hg or fasting blood glucose ≥126 mg/dL and confirmeddiabetes with follow-up HbA1c ≥6.5%. If glucose is elevated ≥126 mg/dL butHbA1c<6.5%, they could still participate.

• Medication changes in past 4 weeks. If participants are on medications for high BPor hyperlipidemia, they will need to have had stable therapy during prior 10 weekswith no planned changes during the study

• Left upper arm circumference >17 inches as this will make BP levels inaccurate withthe home monitor used

• Acute illness or infectious symptoms within the prior 4 weeks.