The eastern North American sea level pressure dipole (ENA) pattern is a recently identified teleconnection pattern that has been shown to influence mid-Atlantic United States (U.S) streamflow variability. Because the pattern was only recently identified, its impacts on U.S. precipitation and estuaries on daily to seasonal timescales is unknown. Thus, this paper presents the first seasonal investigation of ENA relationships with global atmospheric fields, U.S. precipitation, and mid-Atlantic estuarine salinity. We show that the ENA pattern explains up to 25–36% of precipitation variability across Texas and the western U.S. We also show that, for the Northeast U.S, the ENA pattern explains up to 65% of precipitation variability, contrasting with previous work showing how well-known climate indices can only explain a modest amount of precipitation variability. The strongest ENA-precipitation relationships are in the spring and fall. The relationships between the ENA pattern and precipitation across remote regions reflect the upper-atmospheric Rossby wave pattern associated with the ENA pattern that varies seasonally. The El-Nino/Southern Oscillation (ENSO) is related to the spring ENA pattern, indicating that extended outlooks of the ENA pattern may be possible. We also show that the ENA index is strongly correlated with salinity and vertical haline stratification across coastal portions of the mid-Atlantic Bight so that hypoxia forecasts based on the ENA index may be possible. Statistical connections between vertical salinity gradient and ENSO were identified at lags of up two years, further highlighting the potential for extended hypoxia outlooks. The strong connection between anomalies for precipitation and mid-Atlantic Bight salinity suggests that the ENA pattern may be useful at an interdisciplinary level for better understanding historical regional climate variability and future impacts of climate change on regional precipitation and the health of estuaries.