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标题：Effects of Job Strain on Blood Pressure: A Prospective Study of Male and Female White-Collar Workers
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作者：Chantal Guimont ; Chantal Brisson ; Gilles R. Dagenais 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2006
卷号：96
期号：8
页码：1436-1443
DOI：10.2105/AJPH.2004.057679
语种：English
出版社：American Public Health Association
摘要：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. High blood pressure is a major risk factor for cardiovascular disease. 1 ^– 4 Several factors such as age, obesity, 5 ^– 7 sedentary behavior, 6 ^, 8 ^, 9 alcohol consumption, 6 ^, 8 and salt intake 8 ^, 10 ^, 11 may contribute to the development of high blood pressure. Epidemiological studies have shown that psychosocial factors (including workplace psychosocial factors) may contribute to high blood pressure. 12 ^– 16 Most studies examining the association between work-place psychosocial factors and blood pressure have been based on the job strain model developed by Karasek, 17 in which adverse work-place psychosocial factors are defined as a combination of high psychological demands and low decision latitude. Lack of social support in the workplace could further increase the effects of job strain. 18 ^, 19 Studies assessing the impact of job strain on blood pressure have involved several limitations and have generated different results. Some cross-sectional studies using casual blood pressure measurements (i.e., a small number of measurements taken at rest) 20 ^– 23 and most cross-sectional studies assessing ambulatory blood pressure 19 ^, 24 ^– 33 have reported significant associations between job strain and blood pressure. However, cross-sectional designs may be biased by selection effects 34 and do not allow evaluation of the temporal relation between exposure and outcome or the impact of cumulative exposure. To our knowledge, 4 prospective studies have evaluated the effects of cumulative exposure to job strain on blood pressure in normotensive individuals, and these studies have produced mixed results. Chapman et al. 35 and Fauvel et al. 36 found no effect on blood pressure over 5 years of cumulative exposure. Schnall et al. found that systolic and diastolic blood pressure levels were 5.7 and 4.4 mm Hg higher, respectively, among workers with 3 years of cumulative exposure to job strain than among workers who had never been exposed. 29 Moreover, higher blood pressure was found among men who had been employed for 25 years or more and who had been exposed to job strain for 50% of their working life than among men without past exposure to job strain. 37 Recently, Markovitz et al. 38 reported that changes in psychological demands and decision latitude ratios affected systolic blood pressure. Limitations of these studies relate to low (40% 35 ) or unknown 38 participation rates, high rates of loss to follow-up (25%, 35 31.5%, 29 and 38% 38 ), inclusion of exclusively male participants, 29 and use of casual blood pressure measurements. 35 ^, 38 We prospectively evaluated whether cumulative exposure to job strain significantly increased blood pressure levels over a 7.5-year period among men and women employed in white-collar occupations. In addition, we evaluated the potential modifying effects of social support in the workplace.