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Blood Pressure

“In a review conducted in 2000, a majority of the 11 cross-sectional studies of job strain (or its components) and ABP (Ambulatory Blood Pressure) among men found a relationship between job strain and higher work ABP [56]. In the five studies where ABP measurements were also made outside of work, men with job strain also had higher non-work systolic ABP, showing that the impact of job strain on ABP occurred across the whole day and night. Of the six cross-sectional studies of job strain and ABP among women published by 2000, four showed that women with job strain had higher work systolic ABP [94]. Workers with job strain typically have about 4-8 mm Hg higher work systolic ABP than those without job strain. The only longitudinal (long-term) study of job strain and ABP, the New York City Work Site Blood Pressure Study (WSBPS), began in 1985. At the first round of data collection (Time 1), men with job strain showed increases in the size of their heart’s left ventricle, a sign of damage to the heart [95], and had higher levels of work, home, and sleep ABP, after taking into account other risk factors, such as age, race, and weight, than men without job strain [96, 97]. These findings were recently replicated by the Belgian Job Stress Project [98]. Since the study participants returned 3 years later (Time 2), had their BP measured, and completed questionnaires about their jobs, it was possible to create a measure of chronic or longer-term exposure to job strain. Men facing job strain at both Time 1 and Time 2 (longer-term exposure) had an 11-12 mm Hg higher systolic and 6-9 mm Hg higher diastolic work ABP than men not facing job strain at either time. This difference is substantial, more than twice the difference between African Americans and whites in this sample and more than the effect on BP in this study sample of aging 25 years or gaining 50 pounds in weight [99]. To give an idea of the potential benefit of leaving a situation of job strain, those men reporting job strain at Time 1 but no job strain at Time 2 showed a drop in blood pressure 5.3 mm Hg systolic ABP at work and 4.7 mm Hg systolic ABP at home [99].”


Taken from: Schnall PL, Dobson M, Rosskam E, Editors Unhealthy Work: Causes, Consequences, Cures. Baywood Publishing, 2009.

56. Belkic, K., P. A. Landsbergis, P. Schnall, et al., Psychosocial Factors: Review of the Empirical Data among Men, in The Workplace and Cardiovascular Disease Occu- pational Medicine: State of the Art Reviews, Schnall, P., K. Belkic, P. A. Landsbergis, and D. Baker (eds.), Hanley and Belfus, Philadelphia, PA, pp. 24-46, 2000.

94. Brisson, C., Women, Work and Cardiovascular Disease, in The Workplace and Cardiovascular Disease Occupational Medicine: State of the Art Reviews, Schnall, P., K. Belkic, P. A. Landsbergis, and D. E. Baker (eds.), Hanley and Belfus, Philadelphia, pp. 49-57, 2000.

95. Schnall, P. L., C. Pieper, J. E. Schwartz, et al., The Relationship between ‘Job Strain,’ Workplace Diastolic Blood Pressure, and Left Ventricular Mass Index. Results of a Case-Control Study [published erratum appears in JAMA 1992 Mar 4;267(9):1209], Journal of the American Medical Association, 263:14, pp. 1929-1935, 1990.

96. Landsbergis, P. A., P. L. Schnall, K. Warren, T. G. Pickering, and J. E. Schwartz, Association between Ambulatory Blood Pressure and Alternative Formulations of Job Strain, Scandinavian Journal of Work, Environment and Health, 20:5, pp. 349-363, 1994.

97. Schnall, P. L., J. E. Schwartz, P. A. Landsbergis, K. Warren, and T. G. Pickering, Relation between Job Strain, Alcohol, and Ambulatory Blood Pressure, Hypertension, 19, pp. 488-494, 1992.

98. Clays, E., F. Leynen, D. De Bacquer, et al., High Job Strain and Ambulatory Blood Pressure in Middle-Aged Men and Women from the Belgian Job Stress Study, Journal of Occupational and Environmental Medicine, 49, pp. 360-367, 2007.

99. Schnall, P. L., P. A. Landsbergis, J. Schwartz, K. Warren, and T. G. Pickering, A Longitudinal Study of Job Strain and Ambulatory Blood Pressure: Results from a Three-Year Follow-Up, Psychosomatic Medicine, 60, pp. 697-706, 1998.

Heart Disease

“Cardiovascular disease (CVD), including heart disease and stroke, is the major cause of disease and death in the industrialized world and is projected to become the most common cause of death worldwide by the year 2020. CVD and hypertension (high blood pressure) appear to be epidemics of recent historical origin, developing along with industrialization and urbanization, and now increasing in the context of economic globalization. Modern medicine focuses on individual risk factors for hypertension and CVD, often ignoring the important role that social factors, such as social class, work organization, and work-related psychosocial stressors, play in the development of hypertension and CVD. Social factors need to be fully integrated into explanations of disease development.

Increased CVD risk has been associated with job characteristics such as long work hours, shift work, “job strain” (a combination of high psychological work demands and low job decision latitude, or job control), high job efforts combined with low job rewards, injustice, job insecurity, and work that involves maintaining a high level of vigilance in order to avoid disaster, such as loss of human life. Sources of stress on the job (job stressors), besides acting directly on the human nervous system, may increase the risk of hypertension and CVD through a variety of mechanisms, including inhibiting healthy behaviors such as smoking cessation and exercise, or by producing psychological distress, such as anxiety and depression. Public health strategies are needed to address the pandemic of CVD, including worksite surveillance, development of the field of occupational cardiology, integration of health promotion with occupational health approaches, and job redesign.”*

*Taken from: Schnall PL, Dobson M, Rosskam E, Editors Unhealthy Work: Causes, Consequences, Cures. Baywood Publishing, 2009.


Effects of Job Strain on Blood Pressure: A Prospective Study of Male and Female White-Collar Workers

Chantal Guimont, MD, PhD, Chantal Brisson, PhD, Gilles R. Dagenais, MD, FRCP, Alain Milot, MD, MSc, FRCP, Michel Vézina, MD, MPH, FRCP, Benoît Mâsse, PhD, Jocelyne Moisan, PhD, Nathalie Laflamme, PhD, and Caty Blanchette, MS

American Journal of Public Health | August 2006, Vol 96, No. 8

Objectives. We evaluated whether cumulative exposure to job strain increases blood pressure.

Methods. A prospective study of 8395 white-collar workers was initiated during 1991 to 1993. At follow-up, 7.5 years later, 84% of the participants were reassessed to estimate cumulative exposure to job strain.

Results. Compared with men who had never been exposed, men with cumulative exposure and those who became exposed during follow-up showed significant systolic blood pressure increments of 1.8 mm Hg (95% confidence interval [CI] = 0.1, 3.5) and 1.5 mm Hg (95% CI= 0.2, 2.8), respectively, and relative risks of blood pressure increases in the highest quintile group of 1.33 (95% CI= 1.01, 1.76) and 1.40 (95% CI= 1.14, 1.73). Effect magnitudes were smaller among women. Effects tended to be more pronounced among men and women with low levels of social support at work.

Conclusions. Among these white-collar workers, exposure to cumulative job strain had a modest but significant effect on systolic blood pressure among men. The risk was of comparable magnitude to that observed for age and sedentary behavior. Men and women with low levels of social support at work appeared to be at higher risk for increases in blood pressure. (Am J Public Health. 2006;96: 1436–1443. doi:10.2105/AJPH.2004.057679

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