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Hypothetically, blood lead may be involved in blood pressure elevations owing to a facilitation of vascular adrenergic stimulation by extrinsic factors like alcohol. We therefore investigated whether self-reported alcohol consumption was a modifier of the blood lead-blood pressure relation in 3,664 men and women, age 28–67 years, from the MONICA Augsburg study in Germany. In women, only heavy drinkers (40 gm alcohol per day or more) showed a strong relation of blood lead with systolic and diastolic blood pressure, whereas little association was observed for abstaining and for moderately drinking women. In men, we found similar alcohol modifications of the lead-pressure relation only for those with rural, rather than urban, places of residence. We have no explanation for this subgroup divergence. Our results may be taken to indicate a possible role of alcohol consumption in modifying the action of lead on blood pressure.