The impact of environmental pollution and climate change on hypertension: a position paper by the European Society of Hypertension (ESH) Working Group on Environment in Hypertension

Environmental pollution - including air, noise, and light - and progressive climate change are major contributors to global health burdens, responsible for over 9 million premature deaths annuallysa. Among environmental exposures, air and noise pollution show the strongest epidemiological links to hypertension and cardiovascular disease, while emerging evidence also implicates light pollution, toxic metal exposure, and climate-related factors. Hypertension, the leading global cause of mortality, is increasingly recognized as a sentinel marker of environmental damage. Fine particulate matter (PM2.5) and road traffic noise exposure are associated with significant increase in hypertension prevalence and incidence. While historical guidelines overlooked environmental contributors, recent updates by the European Society of Hypertension (ESH) and European Society of Cardiology (ESC) have integrated environmental risk factors into hypertension management frameworks. This position paper from the ESH Working Group on Environment and Hypertension synthesizes current evidence on the epidemiology and pathophysiology of environmental pollution in the development of hypertension. It highlights the mechanistic pathways involving oxidative stress, vascular dysfunction, and neurohormonal dysregulation triggered by pollution exposure. Importantly, the paper outlines mitigation strategies at both population and individual levels, including legislative initiatives, urban planning, and personal exposure reduction techniques. Considering hypertension as an early manifestation of environmental harm offers a critical opportunity for preventive intervention. It is vital to emphasize strict blood pressure control, enhanced screening in high-risk populations and the integration of environmental exposure monitoring into clinical practice. This comprehensive document seeks to raise awareness among healthcare professionals and inform evidence-based strategies for reducing pollution-related hypertension and cardiovascular morbidity.