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Angela Ibald-Mulli,^1,2 Kirsi L. Timonen,^3,4 Annette Peters,¹ Joachim Heinrich,¹ Gabriele Wölke,^1,2 Timo Lanki,⁴ Gintautas Buzorius,⁵ Wolfgang G. Kreyling,^6,7 Jeroen de Hartog,⁸ Gerard Hoek,⁸ Harry M. ten Brink,⁹ and Juha Pekkanen⁴

¹Institute of Epidemiology, GSF-National Research Centre for Environment and Health, Neuherberg, Germany; ²IBE Department of Epidemiology, Ludwig-Maximilians-University, Munich, Germany; ³Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland; ⁴Unit of Environmental Epidemiology, National Public Health Institute, Kuopio, Finland; ⁵Department of Physical Science, Helsinki University, Helsinki, Finland; ⁶Institute of Inhalation Biology, GSF-National Research Centre for Environment and Health, Neuherberg, Germany; ⁷Focus Network Aerosols and Health, GSF-National Research Centre for Environment and Health, Neuherberg/Munich, Germany; ⁸Environmental and Occupational Health Unit, Institute for Risk Assessment Sciences University of Utrecht, Utrecht, the Netherlands; ⁹Energy Research Centre of the Netherlands, Petten, the Netherlands

Abstract
Given the hypothesis that air pollution is associated with elevated blood pressure and heart rate, the effect of daily concentrations of air pollution on blood pressure and heart rate was assessed in 131 adults with coronary heart disease in Helsinki, Finland ; Erfurt, Germany ; and Amsterdam, the Netherlands. Blood pressure was measured by a digital monitor, and heart rate was calculated as beats per minute from an electrocardiogram recording with the patient in supine position. Particle concentrations were measured at central measuring sites. Linear regression was used to model the association between 24-hr mean concentrations of particles and blood pressure and heart rate. Estimates were adjusted for trend, day of week, temperature, barometric pressure, relative humidity, and medication use. Pooled effect estimates showed a small significant decrease in diastolic and systolic blood pressure in association with particulate air pollution ; a slight decrease in heart rate was found. Of the three centers, Erfurt revealed the most consistent particle effects. The results do not support findings from previous studies that had shown an increase in blood pressure and heart rate in healthy individuals in association with particles. However, particle effects might differ in cardiac patients because of medication intake and disease status, both affecting the autonomic control of the heart. Key words: autonomic control, blood pressure, cardiovascular disease, fine and ultrafine particles, heart rate. Environ Health Perspect 112:369-377 (2004) . doi:10.1289/ehp.6523 available via http://dx.doi.org/ [Online 1 December 2003]

Address correspondence to A. Ibald-Mulli, GSF- National Research Centre for Environment and Health, Institute of Epidemiology, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany. Telephone: 49-89-3187-3512. Fax: 49-89-3187-3380. E-mail: ibald@gsf.de

This project was funded by the EU ENVIRONMENT and CLIMATE Research Programme contract ENV4-CT97-0568. The project was coordinated by the Unit of Environmental Epidemiology, National Public Health Institute, Kuopio, Finland, with funding also from the Academy of Finland.

The authors declare they have no competing financial interests.

Received 13 June 2003 ; accepted 1 December 2003.