Ambulatory blood pressure monitoring (ABPM) shows promise as a measure for assessing cardiovascular health benefits of clean cooking interventions, according to a study published in Environmental Health.

Cardiovascular disease (CVD) is a well-established cause of illness and death globally, with over 80% of CVD-related deaths occur in low- and middle-income countries. While the health effects of exposure to ambient air pollution and tobacco smoke have been well documented, at present there is a lack of direct evidence linking household air pollution to cardiovascular disease.  More clarity is needed on how best to measure short term indicators of cardiovascular health, such as blood pressure, in order to better estimate the health benefits of clean cooking adoption.

ABPM is a non-invasive and inexpensive method of obtaining blood pressure (BP) readings over a 24-hour period. Using devices on a patient’s wrist, ABPM reads blood pressure at 15-30-minute intervals and is better at predicting future cardiovascular events and target organ damage than clinic blood pressure readings. This study, funded in part by the Alliance, marks one of the first times ABPM has been used to monitor cookstove interventions in a rural African setting.

The Study

The study, carried out by researchers at the Mailman School of Public Health, Columbia University, monitored the blood pressure of 44 pregnant women in Ghana using the ABPM method or the home blood pressure monitoring (HBPM) method. Two measurements were taken 3-4 weeks apart to measure baseline and post-intervention BP.  By measuring carbon monoxide exposure alongside blood pressure, researchers could also better pinpoint the potential causes of blood pressure spikes, such as exposure to smoke from cooking. The ABPM data revealed elevations in blood pressure in the two hours after peak carbon monoxide exposure, compared to readings following lower exposures. Though the intervention result did not reach statistical significance, women receiving improved cookstoves did show lower post-intervention systolic blood pressure.

All but one of the planned ABPM sessions were completed indicating high feasibility of use in field conditions, with a 92.5% validity for completed sessions. In addition, ABPM readings appeared to be more sensitive to non-dipping nocturnal patterns, which are associated with adverse cardiovascular outcomes.