Hypertension: Could Lowering Job Strain Be a Specific Theraputic Modality?

Details

• Personal Author:
  Belkic K ; Pickering T ; Schnall P ; Schwartz J
• Description:
  The relationship between elevations in blood pressure (BP) and cardiovascular risk is "strong, continuous, graded, consistent, independent, predictive, and etiologically significant for those with and without CHD." From the age of 20 on, in the U.S. and other industrialized settings, BP increases progressively with age for the population as a whole, so that by age 60 approximately 50% of the population has hypertension, according to the standard definition of BP.> 140/90 mmHg. It is now clear that an increase in BP, even for those at a far lower level of BP than the current definition of hypertension, is associated with an increase in CHD risk. 7 With heart disease and stroke representing the first and third leading causes of death in the U.S., respectively, the public health implications of the hypertension epidemic are clear. Essential hypertension is a chronic disease process defined by the presence of persistently elevated (not just acutely elevated) BP, without secondary causes. Epidemiologic evidence reveals that essential hypertension is a disease of industrialized society, as there is a minimal hypertension disease burden among hunter-gatherers, nonmarket agricultural communities, and other nonindustrialized societies. Within industrial society, hypertension is socially patterned by class, race, and gender. Current evidence suggests that the "unidentified" cause(s) of essential hypertension most likely include one or more ubiquitous exposures. Thus, diet, lifestyle, work, and community should be examined. An adequate explanatory risk factor would also have to be consistent with the above-mentioned social patterning of the disease. Migration studies strongly suggest that genetic factors are not the primary determinants of hypertension. This is dramatically demonstrated by the fact that African-Americans have among the highest rates of hypertension in the world, whereas in rural West Africa (from whence African-Americans underwent forced migration to the U.S.) the prevalence of hypertension is among the lowest in the world. The contemporary work environment is a ubiquitous environmental exposure. It is the locus in which adults now spend the majority of their waking time. The work environment is frequently the source of exposures to psychosocial, physical, and other cardionoxious factors. We know that BP is higher during working hours, compared to leisure time, within a 24-hour period.328 Furthermore, mean 24-hour BPs are lower on nonwork days compared to work days. 286 These observations have been made possible by the development of ambulatory blood pressure (AmBP) devices, and their use in working populations. In comparison to casual clinic BP, AmBP is a better reflection of "true blood pressure" and has been demonstrated to be superior to the former in predicting target organ damage (such as left ventricular hypertrophy) and clinical prognosis. Thus, studies using AmBP provide indispensable insights into the link between environmental/situational factors and hypertension. Whether, how, and when repeated acute rises in BP transform into the chronic process of essential hypertension are only partially understood. Clearly, longitudinal studies that follow this process over time are critical to our understanding of the mechanisms involved. Our goal is to present the current biological models and existing empirical evidence, to identify where the argument of biological plausibility is best substantiated. [Description provided by NIOSH]
• Subjects:
  Age Factors Cardiovascular Diseases Cardiovascular System Occupational Health Risk Assessment Risk Factors Safety Stress, Psychological
• Keywords:
  Age Factors Biological Effects Blood Pressure Cardiovascular Disease Heart Disease Hypertension Job Stress Risk Factors Sociological Factors
• ISSN:
  0885-114X
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  California ; OSHA Region 9
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  121-132
• Volume:
  15
• Issue:
  1
• NIOSHTIC Number:
  nn:20058217
• Citation:
  Occup Med: State of the Art Rev 2000 Jan-Mar; 15(1):121-132
• Federal Fiscal Year:
  2000
• Performing Organization:
  University of California, School of Public Health, Los Angeles, CA
• Peer Reviewed:
  True
• Start Date:
  19990701
• Source Full Name:
  Occupational Medicine: State of the Art Reviews
• End Date:
  20040630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:15a3cc6d22a86c4d359b26c9c6b4972a89ee2dc9f88122b71c8269ae5f96947d3e9cff280f695375d5d2ad8854d54b6def741bc52e292348204b5e624fbdd22c
• Download URL:
  https://stacks.cdc.gov/view/cdc/221350/cdc_221350_DS1.pdf
• File Type:
  [PDF - 1.01 MB ]