Hypertension at the Workplace – an Occult Disease? The Need for Work Site Surveillance

Details

• Personal Author:
  Baker, Dean B. ; Belkic KL ; Gerber LM ; Landsbergis PA ; Pickering TG ; Schnall PL ; Schwartz JE
• Description:
  Approximately half of the adult population in industrialized countries has a persistently elevated blood pressure (BP) > 140/90 mm Hg by age 60. The morbidity and mortality associated with essential hypertension (EH) is well established, and the increased risk begins at BP levels substantially lower than the traditional cutoff of 140/90 mm Hg. This major epidemic appears to be socially patterned: as a disease of industrialized societies, with minimal hypertension burden in nonmarket agricultural communities, hunter-gatherers and other nonindustrialized societies. The rising prevalence of hypertension seems to parallel the transformation in working life during the past century, away from agricultural work and relatively autonomous craft-work towards machine-based (including computer-dependent) labor, as is characteristic, e.g., of mass production. An emerging body of scientific evidence implicates specific features of work as important causes of hypertension. As recently argued by Schnall et al. 'The contemporary work environment is the locus in which adults now spend the majority of their waking hours, performing activities which are increasingly characterized, both by scientists and the workers, as demanding, constraining and highly stressful.' (These characteristics are embodied in the concept of job strain: work which is both psychologically demanding and which offers low decision-making latitude.) 'We know that for most people blood pressure is elevated during working hours. We also know that performing demanding, constraining and otherwise mentally stressful activity provokes sharp rises in BP. We can ask the question: Do these observations suggest a way to better tackle the epidemic of EH? Could it be that we are diagnosing some cases of EH too late, by failing to target the role of work in its etiology? As we will elaborate in this paper, it appears that for many people, before BP becomes persistently elevated, there may be a phase of 'occult hypertension at the workplace', in which casual BP remains normal in the clinic setting, but is high during work. We will suggest that reliance upon casual clinic blood pressure determination has contributed to an overemphasis upon those who respond with an acute rise in BP to an atypical psychosocial situation, that of the doctor's (or other health professional's) office. This BP response is very often unrepresentative of the person's usual BP, and this white coat hypertension is of low prognostic value. Meanwhile, people who may be at high risk, those with workplace hypertension, often go undetected. We will suggest ways to more efficiently use the potential of ambulatory BP (AmBP) monitoring techniques, in conjunction with other, more widely applicable methods to maximize diagnostic yield with respect to workplace hypertension. This will be linked to a targeted approach to surveillance of high-risk workplaces, as a key public health strategy. [Description provided by NIOSH]
• Subjects:
  Cardiovascular Diseases Cardiovascular System Occupational Health Safety Stress, Psychological
• Keywords:
  Blood Pressure Health Effects Hypertension Job Stress Medical Screening Surveillance
• ISBN:
  9783805571913
• ISSN:
  0065-3268
• Publisher:
  S. Karger
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  California ; New York ; OSHA Region 2 ; OSHA Region 9
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  116-138
• Volume:
  22
• NIOSHTIC Number:
  nn:20058029
• Citation:
  Everyday biological stress mechanisms. Theorell T ed. Basel, Switzerland: S. Karger. Adv Psychosom Med 2001 Apr; 22:116-138
• Editor(s):
  Theorell T
• Federal Fiscal Year:
  2001
• Performing Organization:
  University of California, School of Public Health, Los Angeles, CA
• Peer Reviewed:
  True
• Start Date:
  19990701
• Source Full Name:
  Advances in Psychosomatic Medicine
• End Date:
  20040630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:8d8003c2b9dae96a67491b8761e4589333b30ebbec5206ec3537ddb817861cd2e71e188fb29c4ae64a2e1ac0ae5d8bd6898e129896a28ca89fb6823a33dc1029
• Download URL:
  https://stacks.cdc.gov/view/cdc/215220/cdc_215220_DS1.pdf
• File Type:
  [PDF - 785.00 KB ]