Abstract
BACKGROUND: Hypertension is a major global health concern and a leading cause of mortality, contributing to functional and structural damage in vital organs. Emerging evidence suggests that household air pollution (HAP) from the combustion of cooking fuels, plays a critical role in influencing the prevalence and mortality rates of hypertension. This systematic review and meta-analysis aims to investigate the association between different cooking fuel types and hypertension risk. METHODS: The study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered with PROSPERO (CRD42024589847). A comprehensive literature search was performed across multiple databases, including PubMed, Embase, Cochrane, WOS, CNKI, VIP, Wanfang, and SinoMed up to September 3, 2024. Study quality was assessed using the Newcastle-Ottawa Scale (NOS) and the National Institutes of Health (NIH) Quality Assessment Tool. Statistical analyses were conducted using Stata 15.1 software. Heterogeneity was assessed using the Q-test and I² statistic, and an appropriate random-effects model (REM) or fixed-effects model (FEM) was applied based on the degree of heterogeneity observed. RESULTS: The analysis revealed that the use of solid cooking fuels was significantly associated with increased odds of hypertension compared to clean cooking fuels (OR = 1.13, 95% CI: 1.03–1.25). Solid cooking fuel use was associated with higher systolic blood pressure (SMD = 0.12, 95% CI: 0.01–0.24), although the difference may be close to the critical level. However, the association with diastolic blood pressure was not significant (SMD = 0.05, 95% CI: -0.06–0.16). Neither subgroup analysis nor meta-regression identified sources of heterogeneity, while sensitivity analyses and subgroup analysis confirmed robust results.Sensitivity analyses confirmed the stability of the results, with no evidence of significant publication bias. CONCLUSIONS: This study provides evidence that solid cooking fuel use is associated with an elevated risk of hypertension. Despite limitations such as heterogeneity across study designs, the findings provide a strong scientific basis for policy interventions promoting a transition to cleaner cooking fuels. Future research should prioritize longitudinal or prospective study designs to enhance the quality of evidence and further elucidate this relationship. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-025-26168-5.