1. Hypertension and Exposure to Noise Near Airports: the HYENA study Jarup L, Babisch W, Houthuijs D, Pershagen G, Katsouyanni K, Cadum E, Dudley ML, Savigny P, Seiffert I, Swart W, Breugelmans O, Bluhm G, Selander J, Haralabidis A, Dimakopoulou K, Sourtzi P, Velonakis M, Vigna-Taglianti F; HYENA study team.

2. What is Noise? Noise is created when an object vibrates. This causes air to compress and expand forming waves. These various resulting pressure waves travel from the source in all directions. Noise waves have a frequency (waves/sec) and amplitude (wave height)

3. Hypertension Systolic BP greater or equal to 140 Diastolic BP greater or equal to 90 Hypertension is a major risk factor for heart disease and stroke.

4. Sources of Noise Pollution Outdoor Construction Road Traffic Airports Factories Indoor Appliances Phone Power tools TV The main source of noise pollution today comes from increasing population and urbanization.

5. HYENA study: Purpose The objective of the Hypertension and Exposure to Noise near Airports (HYENA) study was to assess the relationships between exposure to noise generated by aircraft and road traffic near airports and the risk of hypertension.

6. HYENA study: Methods Population: 45-70 years of age Residents lived near one of 6 European airports for 5 years or more London Heathrow, Berlin Tegel, Amsterdam Schiphol, Stockholm Arlanda, Milan Malpensa, Athens Elephterios Venizelos Airports

7. HYENA study: Methods Blood Pressure Staff assessed BP three times at home visits while the participant was sitting Beginning of interview after a 5 minute rest 1 minute after the first BP recording End of interview (approx 1 hr) Followed the recommendations of the American Heart Association The mean of the first two BP readings were used in this study.

8. HYENA study: Methods Exposure Assessment Aircraft noise Integrated Noise Model served as the standard in 5 airports to calculate noise levels Germany, Netherlands, Sweden, Italy, and Greece Ancon model was used in the United Kingdom Spatial resolution of 250x250m was used

9. HYENA study: Methods Exposure Assessment Road Traffic Noise Various local models were used to determine standards Calculation of Road traffic noise-UK, Richtlinien fur den Larmschutz an Straben-Italy & Germany, Standaard Reken-en Meetvoorschrift-Greece and Netherlands, Nordic Prediction Method-Sweden Spatial resolution of 10x10m was used

10. HYENA study: Methods Statistical Analysis SAS and EGRET Used logistic regression models Hypertension as outcome variable and exposure variable and confounders as covariates. 95% confidence interval 5-db categories showed linear relationships so in the final analysis continuous data was used to increase the statistical power.

11. HYENA study: Results 4,861 participants (2,404 men and 2,457 women) Participation rates varied throughout the countries Country, physical activity, and education were all confounders which proved to be statistically significant.

12. HYENA study: Results This shows the odds ratios in relation to aircraft noise during the day on the left and night time on the right. A rise in odds ratios with an increasing exposure is indicated primarily for night-time noise. The error bars represent the 95% CI for the categorical analysis. The broken and unbroken curves represent continuous analysis.

13. HYENA study: Results Shown in this graph, are the odds ratios and confidence intervals for hypertension in men (right) and women (left) in relation to daily average road traffic noise exposure. You can see an increasing risk for men related to increasing exposure but no such trend for women. The difference between sexes here is significant (p=0.004)

14. HYENA study: Results This is a forest plot which shows country specific odds ratios for hypertension per 10-dB increase in noise exposure, in relation to night time aircraft noise (A), daytime aircraft noise (B), and road traffic noise (C).

15. HYENA study: Conclusion There is excess risk of hypertension related to long-term noise exposure, especially for night-time aircraft noise and daily average road traffic noise.

16. HYENA study: Discussion Higher risk for night time noise could be caused by residents being in their home at night as opposed to being home in the daytime. Further research is needed to determine the reason for the sex differences in risk related to road traffic noise exposure

17. HYENA study: Discussion How would the inclusion of participants outside of the age range of this study change the results?

18. Reference Jarup L, Babisch W, Houthuijs D, Pershagen G, Katsouyanni K, et al. 2007 Hypertension and Exposure to Noise Near Airports: the HYENA Study. Environ Health Perspect 116(3): doi:10.1289/ehp.10775