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Job Strain and Ambulatory Blood Pressure: A Meta-Analysis and Systematic Review

Job Strain and Ambulatory Blood Pressure: A Meta-Analysis and Systematic Review

Paul A. Landsbergis, Marnie Dobson, George Koutsouras, and Peter Schnall.

American Journal of Public Health: March 2013, Vol. 103, No. 3, pp. e61-e71. doi: 10.2105/AJPH.2012.301153

Paul A. Landsbergis, PhD, MPH, Marnie Dobson, PhD, George Koutsouras, MPH, and Peter Schnall,MD, MPHPaul A. Landsbergis and George Koutsouras are with the School of Public Health, State University of New York–Downstate, Brooklyn. Marnie Dobson and Peter Schnall are with the Center for Occupational and Environmental Health, University of California, Irvine. Paul A. Landsbergis, Marnie Dobson, and Peter Schnall are also with the Center for Social Epidemiology, Los Angeles, CA.

Correspondence should be sent to Paul Landsbergis, Associate Professor, Department of Environmental and Occupational Health Sciences, School of Public Health, Box 43, State University of New York–Downstate Medical Center, 450 Clarkson Ave, Brooklyn, NY 11203 (e-mail: paul.landsbergis@downstate.edu). Reprints can be ordered at http://www.ajph.org by clicking the “Reprints” link.

Contributors: P. A. Landsbergis, M. Dobson, and P. Schnall originated and designed the research, acquired the data, drafted the article, and made critical revisions. P. A. Landsbergis, M. Dobson, and G. Koutsouras analyzed and interpreted the data. P. Schnall was responsible for funding and supervision.



We reviewed evidence of the relationship between job strain and ambulatory blood pressure (ABP) in 29 studies (1985–2012). We conducted a quantitative meta-analysis on 22 cross-sectional studies of a single exposure to job strain. We systematically reviewed 1 case–control study, 3 studies of cumulative exposure to job strain, and 3 longitudinal studies.
Single exposure to job strain in cross-sectional studies was associated with higher work systolic and diastolic ABP. Associations were stronger in men than women and in studies of broad-based populations than those with limited occupational variance. Biases toward the null were common, suggesting that our summary results underestimated the true association.
Job strain is a risk factor for blood pressure elevation. Workplace surveillance programs are needed to assess the prevalence of job strain and high ABP and to facilitate workplace cardiovascular risk reduction interventions.

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