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Relationship between outdoor temperature and blood pressure
  1. Jaana I Halonen1,2,
  2. Antonella Zanobetti1,
  3. David Sparrow3,
  4. Pantel S Vokonas3,
  5. Joel Schwartz1
  1. 1Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA
  2. 2School of Public Health and Clinical Nutrition, University of Kuopio, Kuopio, Finland
  3. 3VA Normative Ageing Study, Veterans Affairs Boston Healthcare System and the Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
  1. Correspondence to Jaana I Halonen, Harvard School of Public Health, Landmark Center Room 415 E, 401 Park Drive, Boston, MA 02215, USA; jhalonen{at}


Objectives Cardiovascular mortality has been linked to changes in outdoor temperature. However, the mechanisms behind these effects are not well established. We aimed to study the effect of outdoor temperature on blood pressure, as increased blood pressure is a risk factor for cardiovascular death.

Methods The study population consisted of men aged 53–100 years living in the Boston area. We used a mixed effects model to estimate the effect of three temperature variables: ambient, apparent and dew point temperature (DPT), on repeated measures (every 3–5 years) of diastolic (DBP) and systolic blood pressure (SBP). Random intercepts for subjects and several possible confounders were used in the models, including black carbon and barometric pressure.

Results We found modest associations between DBP and ambient and apparent temperature. In the basic models, DBP in association with a 5°C decrease in 7-day moving averages of temperatures increased by 1.01% (95% CI −0.06% to 2.09%) and 1.55% (95% CI 0.61% to 2.49%) for ambient and apparent temperature, respectively. Excluding extreme temperatures strengthened these associations (2.13%, 95% CI 0.66% to 3.63%, and 1.65%, 95% CI 0.41% to 2.90%, for ambient and apparent temperature, respectively). Effect estimates for DPT were close to null. The effect of apparent temperature on SBP was similar (1.30% increase (95% CI 0.32% to 2.29%) for a 5°C decrease in 7-day moving average).

Conclusions Cumulative exposure to decreasing ambient and apparent temperature may increase blood pressure. These findings suggest that an increase in blood pressure could be a mechanism behind cold-related, but not heat-related, cardiovascular mortality.

  • Cardiovascular
  • blood pressure
  • climate
  • Epidemiology
  • temperature
  • environment

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  • Funding This work was supported by National Institute of Environmental Health Sciences grants ES014663, ES 15172 and ES-00002, and by U.S. EPA grant R83241. The VA Normative Ageing Study is supported by the Cooperative Studies Program/Epidemiology Research and Information Centers of the U.S. Department of Veterans Affairs and is a component of the Massachusetts Veterans Epidemiology Research and Information Center, Boston, Massachusetts. Financial support for Jaana I Halonen from the Finnish Cultural Foundation and Finnish Foundation for Cardiovascular Research is warmly acknowledged.

  • Competing interests None.

  • Ethics approval The study was approved by the Human Subject's Committee of the Harvard School of Public Health, and the IRB of the U.S. Veteran's Administration.

  • Provenance and peer review Not commissioned; externally peer reviewed.