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Psychosocial Stressors at Work and Ambulatory Blood Pressure

  • Psychological Aspects of Cardiovascular Diseases (A Steptoe, Section Editor)
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Abstract

Purpose of Review

Psychosocial stressors at work from the demand-latitude and effort-reward imbalance models are adverse exposures affecting about 20–25% of workers in industrialized countries. This review aims to summarize evidence on the effect of these stressors on blood pressure (BP).

Recent Findings

Three systematic reviews have recently documented the effect of these psychosocial stressors at work on BP. Among exposed workers, statistically significant BP increases ranging from 1.5 to 11 mmHg have been observed in prospective studies using ambulatory BP (ABP). Recent studies using ABP have shown a deleterious effect of these psychosocial stressors at work on masked hypertension as well as on blood pressure control in pharmacologically treated patients.

Summary

Evidence on the effect of these psychosocial stressors on BP supports the relevance to tackle these upstream factors for primary prevention and to reduce the burden of poor BP control. There is a need for increased public health and clinical awareness of the occupational etiology of high BP, hypertension, and poor BP control.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Parent-Thirion A, Fernandez Macías E, Hurley J, Vermeylen GG. Fourth European Working Conditions Survey. Luxembourg; 2007.

  2. Compton S. What’s stressing the stressed? Main sources of stress among workers. Statistics Canada Catalogue. 2011;11-008:44–51.

    Google Scholar 

  3. Sauter S, Murphy L, Colligan M, Swanson N, Hurrell JJ, Scharf FJ, et al. Stress ... at work. Cincinati: U.S. Department of Health and Human Services—NIOSH; 1999.

  4. Milczarek M, Schneider E, González E. OSH in figures: stress at work—facts and figures. Luxembourg: European Agency for Safety and Health at Work; 2009.

    Google Scholar 

  5. Kivimaki M, Nyberg ST, Batty GD, Fransson EI, Heikkila K, Alfredsson L, et al. Job strain as a risk factor for coronary heart disease: a collaborative meta-analysis of individual participant data. Lancet. 2012;380(9852):1491–7.

    Article  Google Scholar 

  6. Stansfeld S, Candy B. Psychosocial work environment and mental health--a meta-analytic review. Scand J Work Environ Health. 2006;32(6):443–62.

    Article  Google Scholar 

  7. Hauke A, Flintrop J, Brun E, Rugulies R. The impact of work-related psychosocial stressors on the onset of musculoskeletal disorders in specific body regions: a review and meta-analysis of 54 longitudinal studies. Work Stress. 2011;25(3):243–56.

    Article  Google Scholar 

  8. Vézina M Theorell T Brisson C. Le stress professionel: approche épidémiologique. In: Découverte L, (editor). Les risques au travail: pour ne pas perdre sa vie à la gagner; 2015.

  9. Brisson C, Aboa-Eboulé C, Leroux I, Gilbert-Ouimet M, Vézina M, Bourbonnais R, et al. Psychosocial factors at work and heart disease. In: Allan R, editor. Heart & Mind: the evolution of cardiac psychology focused on clinical psychology. New-York: American Psychological Association; 2011.

    Google Scholar 

  10. Statistics Canada Table 13-10-0451-01 Health indicators, annual estimates, 2003–2014. 2015 [cited 2018 July 10]; Available from: https://www150.statcan.gc.ca/n1/en/catalogue/82-625-X

  11. Karasek R. Job demands, job decision latitude, and mental strain: implications for job redesign. Adm Sci Quaterly. 1979;24:285–308.

    Article  Google Scholar 

  12. Johnson JV, Hall EM, Theorell T. Combined effects of job strain and social isolation on cardiovascular disease morbidity and mortality in a random sample of the Swedish male working population. Scand J Work Environ Health. 1989;15:271–9.

    Article  CAS  Google Scholar 

  13. Siegrist J. Adverse health effects of high-effort/low-reward conditions. J Occup Health Psychol. 1996;1(1):27–41.

    Article  CAS  Google Scholar 

  14. Dzau VJ, Antman EM, Black HR, Hayes DL, Manson JE, Plutzky J, et al. The cardiovascular disease continuum validated: clinical evidence of improved patient outcomes: part I: pathophysiology and clinical trial evidence (risk factors through stable coronary artery disease). Circulation. 2006;114(25):2850–70.

    Article  Google Scholar 

  15. Landsbergis PA, Dobson M, Koutsouras G, Schnall P. Job strain and ambulatory blood pressure: a meta-analysis and systematic review. Am J Public Health. 2013;103(3):e61–71.

    Article  Google Scholar 

  16. Gilbert-Ouimet M, Trudel X, Brisson C, Milot A, Vezina M. Adverse effects of psychosocial work factors on blood pressure: systematic review of studies on demand-control-support and effort-reward imbalance models. Scand J Work Environ Health. 2014;40(2):109–32.

    Article  Google Scholar 

  17. Babu GR, Jotheeswaran AT, Mahapatra T, Mahapatra S, Kumar A Sr, Detels R, et al. Is hypertension associated with job strain? A meta-analysis of observational studies. Occup Environ Med. 2014;71(3):220–7.

    Article  Google Scholar 

  18. Aboa-Eboule C, Brisson C, Maunsell E, Masse B, Bourbonnais R, Vezina M, et al. Job strain and risk of acute recurrent coronary heart disease events. JAMA. 2007;298(14):1652–60.

    Article  CAS  Google Scholar 

  19. Liu JE, Roman MJ, Pini R, Schwartz JE, Pickering TG, Devereux RB. Cardiac and arterial target organ damage in adults with elevated ambulatory and normal office blood pressure. Ann Intern Med. 1999;131(8):564–72.

    Article  CAS  Google Scholar 

  20. Devereux RB, Pickering TG. Relationship between the level, pattern and variability of ambulatory blood pressure and target organ damage in hypertension. J Hypertens Suppl. 1991;9(8):S34–8.

    CAS  PubMed  Google Scholar 

  21. Verdecchia P, Porcellati C, Schillaci G, Borgioni C, Ciucci A, Battistelli M, et al. Ambulatory blood pressure. An independent predictor of prognosis in essential hypertension. Hypertension. 1994;24(6):793–801.

    Article  CAS  Google Scholar 

  22. Hansen TW, Kikuya M, Thijs L, Bjorklund-Bodegard K, Kuznetsova T, Ohkubo T, et al. Prognostic superiority of daytime ambulatory over conventional blood pressure in four populations: a meta-analysis of 7,030 individuals. J Hypertens. 2007;25(8):1554–64.

    Article  CAS  Google Scholar 

  23. Light KC, Turner JR, Hinderliter AL. Job strain and ambulatory work blood pressure in healthy young men and women. Hypertension. 1992;20(2):214–8.

    Article  CAS  Google Scholar 

  24. • Banegas JR, Ruilope LM, de la Sierra A, Vinyoles E, Gorostidi M, de la Cruz JJ, et al. Relationship between clinic and ambulatory blood-pressure measurements and mortality. N Engl J Med. 2018;378(16):1509–20 Recent large-scale study showing a stronger effect of masked hypertension on CVD risk when compared to sustained hypertension.

    Article  Google Scholar 

  25. Pickering TG, Davidson K, Gerin W, Schwartz JE. Masked hypertension. Hypertension. 2002;40(6):795–6.

    Article  CAS  Google Scholar 

  26. Pickering TG, Eguchi K, Kario K. Masked hypertension: a review. Hypertens Res. 2007;30(6):479–88.

    Article  Google Scholar 

  27. Peacock J, Diaz KM, Viera AJ, Schwartz JE, Shimbo D. Unmasking masked hypertension: prevalence, clinical implications, diagnosis, correlates and future directions. J Hum Hypertens. 2014;28(9):521–8.

    Article  CAS  Google Scholar 

  28. Fagard RH, Cornelissen VA. Incidence of cardiovascular events in white-coat, masked and sustained hypertension versus true normotension: a meta-analysis. J Hypertens. 2007;25(11):2193–8.

    Article  CAS  Google Scholar 

  29. Schnall PL, Schwartz JE, Landsbergis PA, Warren K, Pickering TG. A longitudinal study of job strain and ambulatory blood pressure: results from a three-year follow-up. Psychosom Med. 1998;60:697–706.

    Article  CAS  Google Scholar 

  30. Theorell T, Perski A, Akerstedt T, Sigala F, Ahlberg-Hulten G, Svensson J, et al. Changes in job strain in relation to changes in physiological state. Scand J Work Environ Health. 1988;14:189–96.

    Article  CAS  Google Scholar 

  31. Tobe SW, Kiss A, Sainsbury S, Jesin M, Geerts R, Baker B. The impact of job strain and marital cohesion on ambulatory blood pressure during 1 year: the double exposure study. Am J Hypertens. 2007;20(2):148–53.

    Article  Google Scholar 

  32. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360(9349):1903–13.

    Article  Google Scholar 

  33. Gilbert-Ouimet M, Brisson C, Vezina M, Milot A, Blanchette C. Repeated exposure to effort-reward imbalance, increased blood pressure, and hypertension incidence among white-collar workers: effort-reward imbalance and blood pressure. J Psychosom Res. 2012;72(1):26–32.

    Article  CAS  Google Scholar 

  34. Trudel X, Brisson C, Milot A, Masse B, Vezina M. Adverse psychosocial work factors, blood pressure and hypertension incidence: repeated exposure in a 5-year prospective cohort study. J Epidemiol Community Health. 2016;70(4):402–8.

    Article  Google Scholar 

  35. •• Dragano N, Siegrist J, Nyberg ST, Lunau T, Fransson EI, Alfredsson L, et al. Effort-reward imbalance at work and incident coronary heart disease: a multicohort study of 90,164 individuals. Epidemiology. 2017, 28;(4):619–26 Recent multi-cohort study showing an effect of both job strain and ERI exposures on incident coronary heart diseases.

    Article  Google Scholar 

  36. Kivimaki M, Leino-Arjas P, Luukkonen R, Riihimaki H, Vahtera J, Kirjonen J. Work stress and risk of cardiovascular mortality: prospective cohort study of industrial employees. BMJ. 2002;325(7369):857.

    Article  Google Scholar 

  37. Trudel X, Brisson C, Milot A, Masse B, Vezina M. Psychosocial work environment and ambulatory blood pressure: independent and combined effect of demand-control and effort-reward imbalance models. Occup Environ Med. 2013;70(11):815–22.

    Article  Google Scholar 

  38. •• Sara JD, Prasad M, Eleid MF, Zhang M, Widmer RJ, Lerman A. Association between work-related stress and coronary heart disease: a review of prospective studies through the job strain, effort-reward balance, and organizational justice models. J Am Heart Assoc. 2018; 7 (9). Recent review on the effect of job strain, effort-reward imbalance, and organizational justice on coronary heart diseases. One strenght of this review is the inclusion of work stressors from three different models.

  39. Vyas MV, Garg AX, Iansavichus AV, Costella J, Donner A, Laugsand LE, et al. Shift work and vascular events: systematic review and meta-analysis. BMJ. 2012;e4800:345.

    Google Scholar 

  40. •• Kivimaki M, Jokela M, Nyberg ST, Singh-Manoux A, Fransson EI, Alfredsson L, et al. Long working hours and risk of coronary heart disease and stroke: a systematic review and meta-analysis of published and unpublished data for 603,838 individuals. Lancet. 2015;386(10005):1739–46 Recent multi-cohort study showing an effect of long working hours on cardiovascular diseases, which was more pronounced for stroke when compared to coronary heart diseases.

    Article  Google Scholar 

  41. Proper KI, van de Langenberg D, Rodenburg W, Vermeulen RCH, van der Beek AJ, van Steeg H, et al. The relationship between shift work and metabolic risk factors: a systematic review of longitudinal studies. Am J Prev Med. 2016;50(5):e147–e57.

    Article  Google Scholar 

  42. Hayashi T, Kobayashi Y, Yamaoka K, Yano E. Effect of overtime work on 24-hour ambulatory blood pressure. JOEM. 1996;38(10):1007–11.

    CAS  PubMed  Google Scholar 

  43. O'Brien E, Asmar R, Beilin L, Imai Y, Mallion J-M, Mancia G, et al. European society of hypertension recommendations for conventional, ambulatory and home blood pressure measurement. J Hypertens. 2003;21:821–48.

    Article  CAS  Google Scholar 

  44. Franklin SS, O'Brien E, Thijs L, Asayama K, Staessen JA. Masked hypertension: a phenomenon of measurement. Hypertension. 2015;65(1):16–20.

    Article  CAS  Google Scholar 

  45. Verberk WJ, Thien T, de Leeuw PW. Masked hypertension, a review of the literature. Blood Press Monit 2007; 12 (4):267–273.

    Article  Google Scholar 

  46. Trudel X, Brisson C, Milot A. Job strain and masked hypertension. Psychosom Med. 2010;72(8):786–93.

    Article  Google Scholar 

  47. Boucher P, Gilbert-Ouimet M, Trudel X, Duchaine CS, Milot A, Brisson C. Masked hypertension and effort-reward imbalance at work among 2369 white-collar workers. J Hum Hypertens. 2017.

  48. Landsbergis PA, Travis A, Schnall PL. Working conditions and masked hypertension. High Blood Press Cardiovasc Prev. 2013;20(2):69–76.

    Article  Google Scholar 

  49. Trudel X, Milot A, Brisson C. Persistence and progression of masked hypertension: a 5-year prospective study. Int J Hypertens. 2013;2013:836387.

    Article  Google Scholar 

  50. Gu Q, Burt VL, Dillon CF, Yoon S. Trends in antihypertensive medication use and blood pressure control among United States adults with hypertension: the National Health and Nutrition Examination Survey, 2001 to 2010. Circulation. 2012;126(17):2105–14.

    Article  CAS  Google Scholar 

  51. McAlister FA, Wilkins K, Joffres M, Leenen FH, Fodor G, Gee M, et al. Changes in the rates of awareness, treatment and control of hypertension in Canada over the past two decades. CMAJ. 2011;183(9):1007–13.

    Article  Google Scholar 

  52. Mezuk B, Kershaw KN, Hudson D, Lim KA, Ratliff S. Job strain, workplace discrimination, and hypertension among older workers: the health and retirement study. Race Soc Probl. 2011;3(1):38–50.

    Article  Google Scholar 

  53. •• Trudel X, Milot A, Gilbert-Ouimet M, Duchaine C, Guenette L, Dalens V, et al. Effort-reward imbalance at work and the prevalence of unsuccessfully treated hypertension among white-collar workers. Am J Epidemiol. 2017;186(4):456–62 This study showed an adverse effect of ERI exposure on blood pressure control among pharmacologically treated patients.

    Article  Google Scholar 

  54. Dickson VV, Howe A, Deal J, McCarthy MM. The relationship of work, self-care, and quality of life in a sample of older working adults with cardiovascular disease. Heart Lung. 2012;41(1):5–14.

    Article  Google Scholar 

  55. Fisher JP, Paton JF. The sympathetic nervous system and blood pressure in humans: implications for hypertension. J Hum Hypertens. 2012;26(8):463–75.

    Article  CAS  Google Scholar 

  56. Lu XT, Zhao YX, Zhang Y, Jiang F. Psychological stress, vascular inflammation, and atherogenesis: potential roles of circulating cytokines. J Cardiovasc Pharmacol. 2013;62(1):6–12.

    Article  CAS  Google Scholar 

  57. Groeschel M, Braam B. Connecting chronic and recurrent stress to vascular dysfunction: no relaxed role for the renin-angiotensin system. Am J Physiol Renal Physiol. 2011;300(1):F1–10.

    Article  CAS  Google Scholar 

  58. Kivimaki M, Virtanen M, Elovainio M, Kouvonen A, Vaananen A, Vahtera J. Work stress in the etiology of coronary heart disease—a meta-analysis. Scand J Work Environ Health. 2006;32(6):431–42.

    Article  Google Scholar 

  59. Theorell T. Commentary triggered by the individual participant data meta-analysis consortium study of job strain and myocardial infarction risk. Scand J Work Environ Health. 2014;40(1):89–95.

    Article  Google Scholar 

  60. Chandola T, Britton A, Brunner E, Hemingway H, Malik M, Kumari M, et al. Work stress and coronary heart disease: what are the mechanisms? Eruopean Heart Journal. 2008;29:640–8.

    Article  Google Scholar 

  61. Nyberg ST, Fransson EI, Heikkila K, Alfredsson L, Casini A, Clays E, et al. Job strain and cardiovascular disease risk factors: meta-analysis of individual-participant data from 47,000 men and women. PLoS One. 2013;8(6):e67323.

    Article  CAS  Google Scholar 

  62. Kivimaki M, Head J, Ferrie JE, Shipley MJ, Brunner E, Vahtera J, et al. Work stress, weight gain and weight loss: evidence for bidirectional effects of job strain on body mass index in the Whitehall II study. Int J Obes (Lond). 2006.

  63. Fujishiro K, Lawson CC, Hibert EL, Chavarro JE, Rich-Edwards JW. Job strain and changes in the body mass index among working women: a prospective study. Int J Obes. 2015;39(9):1395–400.

    Article  CAS  Google Scholar 

  64. Block JP, He Y, Zaslavsky AM, Ding L, Ayanian JZ. Psychosocial stress and change in weight among US adults. Am J Epidemiol. 2009;170(2):181–92.

    Article  Google Scholar 

  65. Trudel X, Brisson C, Milot A, Masse B, Vezina M. Effort-reward imbalance at work and 5-year changes in blood pressure: the mediating effect of changes in body mass index among 1400 white-collar workers. Int Arch Occup Environ Health. 2016;89(8):1229–38.

    Article  Google Scholar 

  66. Brisson CG-O, M. Duchaine, C. Trudel X Vezina M Workplace interventions aiming to improve psychosocial work factors and related health. In: J. Siegrist, M. Wahrendorf, (editor). Work stress and health in a globalized economy. Switzerland: Springer; 2016. p. 333–364.

    Google Scholar 

  67. Bambra C, Egan M, Thomas S, Petticrew M, Whitehead M. The psychosocial and health effects of workplace reorganisation. 2. A systematic review of task restructuring interventions. J Epidemiol Community Health. 2007;61(12):1028–37.

    Article  Google Scholar 

  68. Egan M, Bambra C, Thomas S, Petticrew M, Whitehead M, Thomson H. The psychosocial and health effects of workplace reorganisation. 1. A systematic review of organisational-level interventions that aim to increase employee control. J Epidemiol Community Health. 2007;61(11):945–54.

    Article  Google Scholar 

  69. Bond FW, Bunce D. Job control mediates change in a work reorganization intervention for stress reduction. J Occup Health Psychol. 2001;6(4):290–302.

    Article  CAS  Google Scholar 

  70. Kawakami N, Araki S, Kawashima M, Masumoto T, Hayashi T. Effects of work-related stress reduction on depressive symptoms among Japanese blue-collar workers. Scand J Work Environ Health. 1997;23(1):54–9.

    Article  CAS  Google Scholar 

  71. Bourbonnais R, Brisson C, Vinet A, Vezina M, Abdous B, Gaudet M. Effectiveness of a participative intervention on psychosocial work factors to prevent mental health problems in a hospital setting. Occup Environ Med. 2006;63(5):335–42.

    Article  CAS  Google Scholar 

  72. Nerenberg KA, Zarnke KB, Leung AA, Dasgupta K, Butalia S, McBrien K, et al. Hypertension Canada’s 2018 guidelines for diagnosis, risk assessment, prevention, and treatment of hypertension in adults and children. Can J Cardiol. 2018;34(5):506–25.

    Article  Google Scholar 

  73. Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al. ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2017;2017.

  74. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the task force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013;34(28):2159–219.

    Article  Google Scholar 

  75. Chénard C, Mantha-Bélisle M-M, Vézina M. Risques psychosociaux du travail: des risques à la santé mesurables et modifiables. 2018 [cited 2018 July 10]; Available from: https://www.inspq.qc.ca/sites/default/files/publications/2373_risques_psychosociaux_travail_mesurables_modifiables.pdf

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Correspondence to Xavier Trudel.

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Xavier Trudel, Chantal Brisson, Mahée Gilbert-Ouimet, and Alain Milot declare that they have no conflict of interest.

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Trudel, X., Brisson, C., Gilbert-Ouimet, M. et al. Psychosocial Stressors at Work and Ambulatory Blood Pressure. Curr Cardiol Rep 20, 127 (2018). https://doi.org/10.1007/s11886-018-1070-z

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