Abstract-Bisphenol A (BPA) is a high-volume production chemical that has been suspected to have adverse health effects.Recent studies have suggested that cardiovascular diseases are associated with the BPA exposure. The aim of present study was to investigate the associations of urinary BPA with heart rate variability and blood pressure. We recruited 560 noninstitutionalized elderly citizens from August 2008 to August 2010 in Seoul. All of the participants were Ն60 years old. The participants took medical examinations Յ5 times. Urinary BPA concentration, heart rate variability, and blood pressure were measured at each time. A total of 1511 observations from 521 participants were included in the analyses. We observed that urinary BPA was associated negatively with the root mean square of successive differences for heart rate and positively with blood pressure. BPA is considered to be an endocrine-disrupting chemical, and it shows affinity for estrogen receptors. It was initially considered to be a weak xenoestrogen, but subsequent studies showed that BPA can have effects even at low concentrations.3 In addition, pathways other than binding to estrogen receptors have been proposed. These include the thyroid hormone pathway, binding to glucocorticoid receptors and androgen receptors, or interfering with the central nervous system and immune system. [4][5][6] Epidemiological studies have suggested that BPA could have adverse effects on human health.7 Specifically, BPA exposure has been shown to be associated with increased production of liver enzymes, 8 recurrent miscarriages, 9 premature delivery of fetuses, 10 inflammation and oxidative stress, 11 decreased quality of semen, 12,13 and male sexual dysfunction. 14 In 2008, Lang et al 8 conducted a study investigating the associations between past history of chronic diseases and BPA concentration by analyzing data sets from the National Health and Nutrition Examinations Survey. They reported that the concentration of urinary BPA was associated with history of diabetes mellitus and cardiovascular diseases (CVDs).8 Later, Melzer et al 15 conducted similar analyses using larger National Health and Nutrition Examinations Survey data sets and found association between the concentration of BPA and CVDs but not with diabetes mellitus. More recently, a nested case-control study reported the association between higher BPA exposure and incident coronary artery disease with a dose-response relationship. 16 However, the knowledge on how BPA affects the cardiovascular system is still limited.The cells of the cardiovascular system have estrogen receptors (␣ and ). These receptors are involved in antiatherogenic actions, vasodilation and preservation of vascular integrity, cardiomyocyte survival, and regulation of excitability of smooth muscle cells. 17,18 As a xenoestrogen, BPA may alter these functions of estrogen receptors by mimicking or blocking the action of estrogen. 19 We hypothesized that exposure to BPA is associated with reduced heart rate variability (HRV) and hyperten...