Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Oct;123(10):951-8.
doi: 10.1289/ehp.1408125. Epub 2015 Mar 6.

Long-Term Air Pollution Exposure and Blood Pressure in the Sister Study

Free PMC article

Long-Term Air Pollution Exposure and Blood Pressure in the Sister Study

Stephanie H Chan et al. Environ Health Perspect. .
Free PMC article


Background: Exposure to air pollution has been consistently associated with cardiovascular morbidity and mortality, but mechanisms remain uncertain. Associations with blood pressure (BP) may help to explain the cardiovascular effects of air pollution.

Objective: We examined the cross-sectional relationship between long-term (annual average) residential air pollution exposure and BP in the National Institute of Environmental Health Sciences' Sister Study, a large U.S. cohort study investigating risk factors for breast cancer and other outcomes.

Methods: This analysis included 43,629 women 35-76 years of age, enrolled 2003-2009, who had a sister with breast cancer. Geographic information systems contributed to satellite-based nitrogen dioxide (NO2) and fine particulate matter (≤ 2.5 μm; PM2.5) predictions at participant residences at study entry. Generalized additive models were used to examine the relationship between pollutants and measured BP at study entry, adjusting for cardiovascular disease risk factors and including thin plate splines for potential spatial confounding.

Results: A 10-μg/m(3) increase in PM2.5 was associated with 1.4-mmHg higher systolic BP (95% CI: 0.6, 2.3; p < 0.001), 1.0-mmHg higher pulse pressure (95% CI: 0.4, 1.7; p = 0.001), 0.8-mmHg higher mean arterial pressure (95% CI: 0.2, 1.4; p = 0.01), and no significant association with diastolic BP. A 10-ppb increase in NO2 was associated with a 0.4-mmHg (95% CI: 0.2, 0.6; p < 0.001) higher pulse pressure.

Conclusions: Long-term PM2.5 and NO2 exposures were associated with higher blood pressure. On a population scale, such air pollution-related increases in blood pressure could, in part, account for the increases in cardiovascular disease morbidity and mortality seen in prior studies.

Conflict of interest statement

This manuscript has not been subjected to the U.S. EPA’s required peer and policy review and therefore does not necessarily reflect the views of the agency and no official endorsement should be inferred.

The authors declare they have no actual or potential competing financial interests.


Figure 1
Figure 1
United States map of participant residential locations, with number of participants per state. Each participant is represented by an open blue circle.
Figure 2
Figure 2
Boxplots of PM2.5 and NO2 participant annual average residential concentrations by U.S. census division. Boxes extend from the 25th to the 75th percentile, horizontal bars represent the median, whiskers extend 1.5 times the length of the interquartile range (IQR) above and below the 75th and 25th percentiles, respectively, and outliers are represented as points.
Figure 3
Figure 3
Relationship between blood pressure and annual average air pollution exposure for PM2.5 (left) and NO2 (right). Model 1: Included age and race/ethnicity. Model 2: model 1 + household income, education, marital status, working ≥ 20 hr per week outside the home, perceived stress score, and socioeconomic status z-score. Model 3: model 2 + Rural–Urban Continuum Codes and unpenalized thin-plate regression splines for latitude and longitude. Model 4: model 3 + body mass index, waist-to-hip ratio, smoking status, alcohol use, history of diabetes, and history of hypercholesterolemia. Model 5: model 4 + blood pressure medication use.

Similar articles

See all similar articles

Cited by 39 articles

See all "Cited by" articles


    1. Auchincloss AH, Diez Roux AV, Dvonch JT, Brown PL, Barr RG, Daviglus ML, et al. 2008Associations between recent exposure to ambient fine particulate matter and blood pressure in the Multi-Ethnic Study of Atherosclerosis (MESA). Environ Health Perspect 116486–491.; 10.1289/ehp.10899 - DOI - PMC - PubMed
    1. Baccarelli A, Barretta F, Dou C, Zhang X, McCracken JP, Díaz A, et al. 2011Effects of particulate air pollution on blood pressure in a highly exposed population in Beijing, China: a repeated-measure study. Environ Health 10108; 10.1186/1476-069X-10-108 - DOI - PMC - PubMed
    1. Baumgartner J, Schauer JJ, Ezzati M, Lu L, Cheng C, Patz JA, et al. 2011Indoor air pollution and blood pressure in adult women living in rural China. Environ Health Perspect 1191390–1395.; 10.1289/ehp.1003371 - DOI - PMC - PubMed
    1. Brook RD, Bard RL, Burnett RT, Shin HH, Vette A, Croghan C, et al. Differences in blood pressure and vascular responses associated with ambient fine particulate matter exposures measured at the personal versus community level. Occup Environ Med. 2011;68:224–230. - PubMed
    1. Brook RD, Rajagopalan S, Pope CA, III, Brook JR, Bhatnagar A, Diez-Roux AV, et al. Particulate matter air pollution and cardiovascular disease: an update to the scientific statement from the American Heart Association. Circulation. 2010;121:2331–2378. - PubMed

Publication types