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Eur Heart J. 2017 Apr 1;38(13):983-990. doi: 10.1093/eurheartj/ehw413.

Long-term exposure to ambient air pollution and traffic noise and incident hypertension in seven cohorts of the European study of cohorts for air pollution effects (ESCAPE).

Author information

Environmental Epidemiology Group, Institute of Occupational, Social and Environmental Medicine, Center for Health and Society, Heinrich-Heine-University of Düsseldorf, University Hospital of Düsseldorf, AG Umweltepidemiologie, P.O. Box 101007, 40001 Düsseldorf, Germany.
Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstraße 22, D 89081 Ulm, Germany.
ISGlobal, Centre for Research in Environmental Epidemiology (CREAL). C/ Doctor Aiguader 88, 08003 Barcelona, Spain.
Universitat Pompeu Fabra (UPF), Plaça de la Mercè, 10, 08002 Barcelona, Spain.
Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública, CIBERESP), Av. Monforte de Lemos, 3-5. Pabellón 11. Planta 0, 28029 Madrid, Spain.
Department of Environmental Medicine, Karolinska Institutet, P.O. Box 210, SE-171 77 Stockholm, Sweden.
Institute of Epidemiology II, HMGU - Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology II, Ingolstädter Landstr. 1, D-85764 Neuherberg, Germany.
Division of Environmental Medicine, Norwegian Institute of Public Health, P.O. Box 4404 Nydalen, N-0403 Oslo, Norway.
Diet Genes Environment Unit, Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen, Denmark.
Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, P.O. Box 4002, Basel, Switzerland.
University of Basel, Petersplatz 1, 4003 Basel, Switzerland.
Department of Environmental Science, Aarhus University, Frederiksborgvej 399, 4000 Roskilde, Denmark.
Division of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, P.O. Box 80.178, NL-3508 TD Utrecht, the Netherlands.
Julius Center for Primary Care and Health Sciences, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG Utrecht, the Netherlands.
Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Gävlegatan 16, 113 30 Stockholm, Sweden.
Stockholm University, Universitetsvägen 10, 114 18 Stockholm, Sweden.
Environmental Science Center, the University of Augsburg, Universitätsstraße 1a, 86159 Augsburg, Germany.
Cardiovascular Epidemiology and Genetics Research Group, Hospital del Mar Medical Research Institute (IMIM), Carrer del Dr. Aiguader, 88, 08003 Barcelona, Spain.
Stockholm Gerontology Research Center, Gävlegatan 16, 8 trappor, 113 30 Stockholm, Sweden.
Department of Molecular Medicine and Surgery, Endocrine and Diabetes Unit, Karolinska Institutet, Karolinska University Hospital, Solna (L1:00), SE-171 76 Stockholm, Sweden.
National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA Bilthoven, the Netherlands.
Munich Heart Alliance, Deutsches Zentrum für Herz-Kreislaufforschung e.V. (partner-site Munich), Biedersteiner Strasse 29, 80802 Munich, Germany.



We investigated whether traffic-related air pollution and noise are associated with incident hypertension in European cohorts.

Methods and results:

We included seven cohorts of the European study of cohorts for air pollution effects (ESCAPE). We modelled concentrations of particulate matter with aerodynamic diameter ≤2.5 µm (PM2.5), ≤10 µm (PM10), >2.5, and ≤10 µm (PMcoarse), soot (PM2.5 absorbance), and nitrogen oxides at the addresses of participants with land use regression. Residential exposure to traffic noise was modelled at the facade according to the EU Directive 2002/49/EC. We assessed hypertension as (i) self-reported and (ii) measured (systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg or intake of BP lowering medication (BPLM). We used Poisson regression with robust variance estimation to analyse associations of traffic-related exposures with incidence of hypertension, controlling for relevant confounders, and combined the results from individual studies with random-effects meta-analysis. Among 41 072 participants free of self-reported hypertension at baseline, 6207 (15.1%) incident cases occurred within 5-9 years of follow-up. Incidence of self-reported hypertension was positively associated with PM2.5 (relative risk (RR) 1.22 [95%-confidence interval (CI):1.08; 1.37] per 5 µg/m³) and PM2.5 absorbance (RR 1.13 [95% CI:1.02; 1.24] per 10 - 5m - 1). These estimates decreased slightly upon adjustment for road traffic noise. Road traffic noise was weakly positively associated with the incidence of self-reported hypertension. Among 10 896 participants at risk, 3549 new cases of measured hypertension occurred. We found no clear associations with measured hypertension.


Long-term residential exposures to air pollution and noise are associated with increased incidence of self-reported hypertension.


Air pollution ; Hypertension ; Meta-analysis; Nitrogen oxides ; Particulate matter ; Road traffic noise

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