Published Online
on October 4, 2004

A more recent version of this article appeared on October 12, 2004

This Article Full Text (PDF) All Versions of this Article: 110/15/2184    most recent 01.CIR.0000143831.33243.D8v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Zanobetti, A. Articles by Gold, D. R. Search for Related Content PubMed PubMed Citation Articles by Zanobetti, A. Articles by Gold, D. R. Related Collections Epidemiology Other Research

Submitted on April 28, 2003
Revised on March 23, 2004
Accepted on May 20, 2004

Ambient Pollution and Blood Pressure in Cardiac Rehabilitation Patients

Antonella Zanobetti PhD^*, Marina Jacobson Canner MA, Peter H. Stone MD, Joel Schwartz PhD, David Sher BA, Elizabeth Eagan-Bengston MS, Karen A. Gates MS, L. Howard Hartley MD, Helen Suh PhD, and Diane R. Gold MD, MPH

From the Department of Environmental Health, Harvard School of Public Health (A.Z., J.S., H.S., D.R.G.), and Channing Laboratory (M.J.C., J.S., D.S., E.E.-B., K.A.G., D.R.G.) and Division of Cardiology (P.H.S., L.H.H.), Brigham and Women’s Hospital, Department of Medicine, Harvard Medical School, Boston, Mass.

^* To whom correspondence should be addressed. E-mail: azanobet{at}hsph.harvard.edu.

Background--Multiple studies have demonstrated a consistent association between ambient particulate air pollution and increased risk of hospital admissions and deaths for cardiovascular causes. We investigated the associations between fine particulate pollution (PM_2.5) and blood pressure during 631 repeated visits for cardiac rehabilitation in 62 Boston residents with cardiovascular disease.

Methods and Results--Blood pressure, cardiac risk factor, and exercise data were abstracted from records of rehabilitation visits between 1999 and 2001. We applied mixed-effect models, controlling for body mass index, age, gender, number of visits, hour of day, and weather variables. For an increase from the 10th to the 90th percentile in mean PM_2.5 level during the 5 days before the visit (10.5 µg/m³), there was a 2.8-mm Hg (95% CI, 0.1 to 5.5) increase in resting systolic, a 2.7-mm Hg (95% CI, 1.2 to 4.3) increase in resting diastolic, and a 2.7-mm Hg (95% CI, 1.0 to 4.5) increase in resting mean arterial blood pressure. The mean PM_2.5 level during the 2 preceding days (13.9 µg/m³) was associated with a 7.0-mm Hg (95% CI, 2.3 to 12.1) increase in diastolic and a 4.7-mm Hg (95% CI, 0.5 to 9.1) increase in mean arterial blood pressure during exercise in persons with resting heart rate 70 bpm, but it was not associated with an increase in blood pressure during exercise in persons with heart rate <70 bpm.

Conclusions--In patients with preexisting cardiac disease, particle pollution may contribute to increased risk of cardiac morbidity and mortality through short-term increases in systemic arterial vascular narrowing, as manifested by increased peripheral blood pressure.

Key words: air pollution • blood pressure • cardiovascular diseases • environmental exposure • epidemiology

This article has been cited by other articles:

				A. V. Diez Roux, A. H. Auchincloss, T. G. Franklin, T. Raghunathan, R. G. Barr, J. Kaufman, B. Astor, and J. Keeler Long-term Exposure to Ambient Particulate Matter and Prevalence of Subclinical Atherosclerosis in the Multi-Ethnic Study of Atherosclerosis Am. J. Epidemiol., March 15, 2008; 167(6): 667 - 675. [Abstract] [Full Text] [PDF]

				I. N. Krivoshto, J. R. Richards, T. E. Albertson, and R. W. Derlet The Toxicity of Diesel Exhaust: Implications for Primary Care J Am Board Fam Med, January 1, 2008; 21(1): 55 - 62. [Abstract] [Full Text] [PDF]

				J.-H. Choi, Q.-S. Xu, S.-Y. Park, J.-H. Kim, S.-S. Hwang, K.-H. Lee, H.-J. Lee, and Y.-C. Hong Seasonal variation of effect of air pollution on blood pressure J Epidemiol Community Health, April 1, 2007; 61(4): 314 - 318. [Abstract] [Full Text] [PDF]

				C. A. Pope III, J. B. Muhlestein, H. T. May, D. G. Renlund, J. L. Anderson, and B. D. Horne Ischemic Heart Disease Events Triggered by Short-Term Exposure to Fine Particulate Air Pollution Circulation, December 5, 2006; 114(23): 2443 - 2448. [Abstract] [Full Text] [PDF]

				A. Zanobetti and J. Schwartz Air pollution and emergency admissions in Boston, MA. J Epidemiol Community Health, October 1, 2006; 60(10): 890 - 895. [Abstract] [Full Text] [PDF]

				A. Bhatnagar Environmental Cardiology: Studying Mechanistic Links Between Pollution and Heart Disease Circ. Res., September 29, 2006; 99(7): 692 - 705. [Abstract] [Full Text] [PDF]

				R. D. Brook, M. S. O'Neill, and S. Rajagopalan Letter by Brook et al Regarding Article "Diesel Exhaust Inhalation Causes Vascular Dysfunction and Impaired Endogenous Fibrinolysis" Circulation, June 20, 2006; 113(24): e871 - e871. [Full Text] [PDF]

				F Ballester, P Rodriguez, C Iniguez, M Saez, A Daponte, I Galan, M Taracido, F Arribas, J Bellido, F B Cirarda, et al. Air pollution and cardiovascular admissions association in Spain: results within the EMECAS project. J Epidemiol Community Health, April 1, 2006; 60(4): 328 - 336. [Abstract] [Full Text] [PDF]

				G. A. Wellenius, J. Schwartz, and M. A. Mittleman Air Pollution and Hospital Admissions for Ischemic and Hemorrhagic Stroke Among Medicare Beneficiaries Stroke, December 1, 2005; 36(12): 2549 - 2553. [Abstract] [Full Text] [PDF]

				S. Rajagopalan, Q. Sun, and L. C. Chen Particulate Pollution and Endothelial Function: Deja Vu All Over Again in the Air Circulation, June 7, 2005; 111(22): 2869 - 2871. [Full Text] [PDF]

				R. A. Kloner The "Merry Christmas Coronary" and "Happy New Year Heart Attack" Phenomenon Circulation, December 21, 2004; 110(25): 3744 - 3745. [Full Text] [PDF]