Job characteristics,occupational status,and ambulatory cardiovascular activity in women

Background: Prior research concerning the effects of occupational status and work stress on ambulatory blood pressure (AmBP) has seldom included women, and available results are equivocal. Moreover, the concurrent effects of occupational status and job characteristics have rarely been investigated. Some research is consistent with the idea that stressful job characteristics are especially detrimental to health in low-status workers, creating a cumulative physiological burden.Purpose: To examine the independent and joint effects of occupational status and perceived demands, control, and social support at work on AmBP and heart rate (HR) in women.Methods: One hundred eight women (M age = 41.07 years) wore an AmBP monitor for 2 days and completed a self-report assessment of job control, demands, and support (i.e., Karesek et al.’s Job Content Questionnaire).Results: After controlling for numerous potential confounds, occupational status and job characteristics accounted for 18% and 22% of the inter-individual variability in ambulatory systolic blood pressure (SBP) and HR, respectively. Occupational status independently predicted ambulatory cardiovascular activity and interacted with job characteristics, particularly in relation to SBP.Conclusions: Inasmuch as ambulatory SBP and HR predict future cardiovascular morbidity and mortality, women with both lower status occupations and stressful job circumstances could be at disproportionately high cardiovascular risk. Laura Bogart is now with RAND Corporation, Santa Monica, California. This research was supported in part by a Kent State University Summer Research and Creativity Grant and by NIH Grant MH66101-01. We thank Amy Jones and Evangelia Banou for assistance with data collection and data entry.     

Burn-out among personnel of prisons: Karasek's job demand-control model

The main objective of the present research was to test a path model describing the effects of the dimensions of the Karasek's "job strain" model on burn-out among a sample of personnel of prisons (n=119). This model assumes that the combination of high job demands along with low decision latitude at work precipitates psychological strain and physical illness. Job demands refer to the perceived demands from job and others in the workplace. Decision latitude is an operationalization of the concept of control and has often been defined as the combination of job decision-making authority and the opportunity to use and develop skills on the job.The findings support this model. Indeed, high level of workload acts positively on emotional exhaustion and depersonalization; in contrast, high level of job decisions latitude acts negatively on emotional exhaustion and positively on personnel accomplishment. Limits of this study are discussed.     

Exposure to psychosocial stressors at work in the Pays de la Loire region in 2002

OBJECTIVE: An epidemiological surveillance system of work-related musculoskeletal disorders of the upper limb (MSDs) was implemented in 2002 in the Pays de la Loire region to assess the prevalence of the MSDs and their biomechanical and psychosocial risk factors in the working population. We will report here only the results concerning the exposure to psychosocial stress in the work environment. According to the Karasek "demand-autonomy" model, high psychological work demands may increase risk of ill health, particularly if there is a low level of decision latitude for the employees and low social support by the hierarchy or colleagues. METHODS: In 2002, 68 out a total of 400 occupational physicians volunteered to participate in the surveillance program and included 1 495 workers (895 men, 600 women) representative of the region's workforce. Work history and work environment were assessed by a self-administered questionnaire before the compulsory annual visit of occupational physicians. Exposure to psychosocial stress at work was assessed with the Job Content Questionnaire (JCQ) developed by Karasek. The three scales of decision latitude, social support and psychological demands were calculated using Karasek's recommendations. RESULTS: The mean scores of psychological demands, decision latitude and social support were 69.3 +/- 12.7; 22.3 +/- 3.2; 24.0 +/- 3.5, respectively. No differences were observed according to gender and age. A third of the workers were exposed to high psychological demands at work and most of them (61%) had little decision latitude to cope with work constraints. About 28% of workers suffered from a lack of social support from their colleagues or supervisors. Overall, about 17% of workers were exposed to a situation of "Job strain" (ie a combination of a high level of psychological demands and a low level of decision latitude) and 7% were exposed to a situation of "Job strain" with social isolation ("Job strain" with low social support). The situations of "Job strain", associated or not with a low level of social support, were particularly frequent in industries with taylorized work organisation, like the food industry and automobile industry, and in services characterised by strong merchant constrains, such as trade and cleaning services, for example. The frequency of "Job strain", with or without social isolation, was almost double in temporary workers. DISCUSSION: This study confirms that in a representative sample of workers, the exposure to occupational stress is not limited to managers and professionals, but concerns also a large number of employees and blue-collar workers of the public and private sectors. In general, the strongly qualified occupations are characterised by a high level of psychological demands, but individuals have large decision latitude to cope, which allows them to develop their capacities. The less qualified occupations are generally less confronted with a high level of mental demands than the managers and professionals. However, these individuals do not have enough decision latitude to cope with psychological demands which could lead to a high level of "Job strain", notably in the case of lack of social support from the supervisors and the colleagues. CONCLUSION: The study shows that the exposure to occupational stress is not limited to managers and professionals, but also concerns numerous employees and blue-collar workers. The determinants of work strain differ depending on occupations and this should be taken into consideration when implementing prevention programs for stress at work.     

Neuregulin-1 genotype moderates the association between job strain and early atherosclerosis in young men

Background: Although it is known that a given level of strain does not induce a corresponding CHD risk in all individuals, factors that predict groups at risk have remained unclear. Neuregulin-1 (NRG-1) has various roles in the development and function of the heart and autonomic nervous system.Purpose: We examined whether polymorphic variation in NRG-1 moderates the association between job strain and early atherosclerosis.Methods: The participants (Mage=32.5) were 349 women and 357 men derived from the population-based Cardiovascular Risk in Young Finns study. Job strain was defined as the joint effect of job demands and job control. Preclinical atherosclerosis was measured using carotid intima-media thickness (IMT) ultrasound.Results: NRG-1 single nucleotide polymorphism SNP8NRG221533 (T to C) was found to moderate the association between job strain and IMT in men (p=.04). Job strain was significantly associated with increased IMT among men with T/T genotype but not among the others. A direct association between NRG-1 and IMT was found in women.Conclusions: Our results suggest that the effect of job strain on early ather osclerosis is dependent on NRG-1 genotype in men. Gene×Environment Interaction approach seems to offer important additional information in stress research. This study was supported by Academy of Finland (Grants 111056, 209514, and 209518 for L.K.-J., 104891 and 105195 for M.K., 53392 and 15486 for O.T.R), the Emil Aaltonen Foundation (L.K.-J. and T.L.), the Psykonet Graduate School of Psychology (M.H.), and The Finnish Foundation of Cardiovascular Research (O.T.R).     

Psychosocial stress at work is associated with increased dementia risk in late life

ObjectiveTo test the hypothesis that high job stress during working life might lead to an increased risk of dementia and Alzheimer’s disease (AD) in late life.MethodsA dementia-free cohort of 913 community dwellers, aged 75+ years, from the Kungsholmen Project, a population-based follow-up study carried out in Stockholm, Sweden, was followed up for an average of 6 years to detect incident dementia and AD (third revised Diagnostic and Statistical Manual of Mental Disorders). Information on the lifespan work activities was collected. Psychological stress at work was estimated for the longest period of occupation as well as for all occupations by using a validated psychosocial job exposure matrix on two dimensions: job control and job demands. Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of dementia and AD in relation to different levels of job stress.ResultsLow level of job control was associated with higher multivariate adjusted risk of dementia (HR = 1.9, 95% CI: 1.2–3.0) and AD (HR = 2.2, 95% CI: 1.2–3.9). Low level of job demands alone was not significantly associated with increased dementia risk. When the two dimensions were combined into a four-category job strain model, both high job strain (low control/high demands) and passive strain (both low control and demands) were related to higher risk of dementia and AD as compared with active job strain (both high). Vascular disorders did not mediate the observed associations.ConclusionLifelong work-related psychosocial stress, characterized by low job control and high job strain, was associated with increased risk of dementia and AD in late life, independent of other known risk factors.     

Does race/ethnicity moderate the association between job strain and leisure time physical activity?

Background: Racial/ethnic minorities report myriad barriers to regular leisure time physical activity (LTPA), including the stress and fatigue resulting from their occupational activities.Purpose: We sought to investigate whether an association exists between job strain and LTPA, and whether it is modified by race or ethnicity.Methods: Data were collected from 1,740 adults employed in 26 small manufacturing businesses in eastern Massachusetts. LTPA and job strain data were self-reported. Adjusted mean hours of LTPA per week are reported.Results: In age and gender adjusted analyses, reports of job strain were associated with LTPA. There was a significant interaction between job strain and race or ethnicity (p = .04). Whites experiencing job strain reported 1 less hr of LTPA per week compared to Whites not reporting job strain. Collectively, racial/ethnic minorities reporting job strain exhibited comparatively higher levels of LTPA compared to their counterparts with no job strain, although patterns for individual groups did not significantly differ.Conclusions: Job strain was associated with LTPA in a lower income, multiethnic population of healthy adult men and women. The association between job strain and LTPA was modified by race or ethnicity, highlighting the importance of investigating the differential effects of psychosocial occupational factors on LTPA levels by race or ethnicity. This research was supported by grant no. 5 P01 CA75308 from the National Institutes of Health and support to the Dana—Farber Cancer Institute by Liberty Mutual, National Grid, and the Patterson Fellowship Fund. G. G. Bennett is also supported by an award from the Dana— Farber/Harvard Cancer Center. K. Y. Wolin was supported in part by a National Cancer Institute training grant (5 T32 CA09001–28). We gratefully acknowledge the efforts of Sandy Askew and Jodi Anna Saia—Witte for their assistance with the preparation of this article. We especially appreciate the consultation provided by Jeff Johnson and Paul Landsbergis and the input of this article’s anonymous reviewers.     

The impact of endothelin-1 genetic analysis and job strain on ambulatory blood pressure

Objective

An interaction between the endothelin-1 gene (EDN1), blood pressure (BP) and social determinants has been previously found. Using a well-characterized cohort of participants, the impact of associations between genetic factors and job strain on BP was evaluated.

Methods

A cross-sectional analysis of five polymorphisms covering the EDN1, of which 2 were previously reported to be associated with BP, was performed. Study subjects had previously completed a baseline evaluation including 24-h ambulatory BP monitoring and an assessment of job strain. This report presents the findings for 184 subjects who gave DNA samples for genetic analysis. One-way analysis of variance (ANOVA) was performed between each genetic marker and 24-h systolic blood pressure (SBP) and diastolic blood pressure (DBP), as well as two-way ANOVAs to test the interaction effect with job strain.

Results

Trends for relationships were observed between SBP and two polymorphisms: rs10478694 and rs5369. An interaction between job strain and those heterozygous for two polymorphisms showed higher SBP (P=.029 and .008) and a tendency for higher DBP. All findings were more significant when analyses were confined to the 139 Caucasian subjects.

Conclusion

This is the first study to report an interaction between the EDN1 gene, job strain and BP, supporting previous evidence of a role of this gene in the interaction between environmental stress and ambulatory BP. Given the limited sample size, the results should be considered preliminary, and further studies are required.     

Associations of insomnia with job strain, control, and support among male Japanese workers

ObjectiveTo assess the relationship between job stress and insomnia among office workers.MethodsThis cross-sectional study examined 1209 male workers (mean age 43 years) at periodic health checkups in 2007. Insomnia was defined as consistently experiencing any of three sleep disorder symptoms (i.e., difficulty initiating sleep, difficulty maintaining sleep, and early-morning awakening) in a recent two-week period. Job stress indices included job demand, control, strain (job demand/control), and social support, as measured by the Job Content Questionnaire.ResultsThe prevalence of insomnia was 4.7%. After adjusting for age, perceived daily stress, sleep dissatisfaction, lifestyle factors, and physical comorbidities, the risk of insomnia increased with a higher degree of job strain (odds ratio 2.3, 95% confidence intervals 1.3–4.0) and decreased with a higher degree of job control (0.5, 0.3–0.8). The combination of high job strain with low degree of control or social support had an approximately three times higher risk of insomnia than that of low job strain with high degree of control or support.ConclusionsBoth job strain and job control had an independent effect on insomnia, and the association between job strain and insomnia was mediated by the buffering effects of control and support.     

Negative emotionality, activity, and sociability temperaments predicting long-term job strain and effort-reward imbalance: A 15-year prospective follow-up study

Objective

This study examined a longitudinal association between innate temperament and perceptions of long-term work stressors.

Methods

The sample consisted of 276 men and 345 women (aged 30-45 years in 2007) participating in the prospective population-based Cardiovascular Risk in Young Finns study. In 1992, temperament was self-assessed with the EAS questionnaire that assesses three temperamental traits: negative emotionality, activity, and sociability. Perceived work stressors were measured in 2001 and in 2007 using two models: Karasek's demand/control-model in which a combination of high demands and low control results in job strain, and Siegrist's Effort-reward imbalance (ERI) model.

Results

The results showed that higher negative emotionality and lower sociability systematically predicted higher perceived job strain and ERI (P < .001). Activity predicted higher perceived ERI (P < .05). Activity did not predict perceived job strain, as it was related to both higher perceived demands and higher control.

Conclusions

The results suggest that temperament may be a predisposing factor to the experiences of work stressors in adulthood. Although self-reported job strain and ERI are measures of job characteristics, they are affected by individual temperament.     

Psychosocial job characteristics and insomnia: A prospective cohort study using the Demand-Control-Support (DCS) and Effort–Reward Imbalance (ERI) job stress models

ObjectiveTo examine the prospective effects of psychosocial job characteristics evaluated with the Demand-Control-Support (DCS) and Effort–Reward Imbalance (ERI) models on insomnia.MethodsA prospective cohort study with a two-year observation was performed. The subjects were 1022 middle-aged (?39 years) Japanese workers. The following associations were analyzed: high job strain, low social support, effort–reward imbalance, and overcommitment to work at the baseline with self-reported persistence and future onset of insomnia.ResultsAmong those who were insomniacs at the baseline (N = 292), low social support [adjusted odds ratio (95% CI): 2.00 (1.18, 3.40)] and effort–reward imbalance [2.40 (1.13, 5.10)] at the baseline had a significant relationship to insomnia at the follow-up. Among those who were not insomniacs at the baseline (N = 730), overcommitment to work [1.75 (1.16, 2.66)] and high job strain [1.72 (1.06, 2.79)] at the baseline were associated with insomnia at follow-up.ConclusionsProspective effects of psychosocial job characteristics on insomnia differed between its persistence and future onset. Proportionate reward for work effort and sufficient support at work assist recovery from insomnia, while overcommitment to work and high job strain cause future onset of insomnia.     

Job stress,burnout, and job satisfaction in sleep apnea patients

ObjectiveTo assess job stress, burnout, and job satisfaction in patients with obstructive sleep apnea syndrome (OSAS).MethodsA total of 182 patients with OSAS and 71 healthy individuals completed the Job Content Questionnaire, the Maslach Burnout Inventory – General Survey, the Index of Job Satisfaction, the Epworth Sleepiness Scale, and the Pittsburgh Sleep Quality Index. All participants were assessed with full-night polysomnography.ResultsSurvey scores of patients diagnosed with OSAS only differed from those of the control group in the emotional exhaustion dimension (P = 0.015). According to a multivariate analysis, the apnea–hypopnea index (AHI) was only correlated with perceived support at work (β coefficient = 0.142; P = 0.048). Associations were found between subjective sleep quality, perceived support from coworkers, and supervisors (β = 0.157; P = 0.025), psychological demands (β = 0.226; P = 0.001), emotional exhaustion (β = 0,405; P = 0.000), and cynicism (β = 0.224; P = 0.002). The study also revealed associations between excessive daytime sleepiness and the burnout dimensions emotional exhaustion (β = 0.232; P = 0.000) and cynicism (β = 0.139; P = 0.048).ConclusionObjective parameters of OSAS such as the AHI seem to have limited influence on the psychosocial aspects of the occupational life of patients with OSAS. There is evidence of significant associations between the subjective symptoms of the disease, such as daytime sleepiness, subjective sleep quality, job stress, and burnout.     

Parental socioeconomic position and parental life satisfaction as predictors of job strain in adulthood: 18-year follow-up of the Cardiovascular Risk in Young Finns Study

OBJECTIVE: The objective of this study was to prospectively examine whether parental socioeconomic position (SEP) and parental life satisfaction predict job strain in adulthood. METHODS: The cohort comprised 755 participants from the ongoing Cardiovascular Risk in Young Finns Study. The parents reported their SEP and life satisfaction when the participants were aged 6-21 years. Eighteen years later at ages 24-39 years, the participants responded to a survey on job strain and its components, job control and job demands. RESULTS: According to structural equation modeling, lower parental SEP and higher parental life dissatisfaction independently predicted increased adulthood job strain. Lower parental SEP also predicted lower educational attainment, which in turn was linked with higher job strain and lower job control. We found no gender differences in these predictive relationships. CONCLUSION: Parental SEP and parental life satisfaction are associated with job strain in adulthood, and the effect is partly mediated by education. These prospective data suggest that preemployment factors should be taken into account as potential confounders in future research on job strain-health associations.     

Dementia care and labour market: The role of job satisfaction

Objectives: A labour shortage in the dementia care sector is to be expected in the near future in the Netherlands and in many other European states. The objective of this study is to analyse why people quit or avoid jobs in dementia care.

Method: An integrative analysis was used to study reports, articles, and Website information on the dementia care labour market.

Results: The main reason for quitting a (dementia) care job was the lack of job satisfaction. Job satisfaction was reduced by a lack of appreciation and professionals’ own dissatisfaction about the quality of care they were able to provide. Effects of staff training on job satisfaction, quality of dementia care, and patient functioning are promising.

Conclusion: Job satisfaction is the main cause of quitting (dementia) care jobs. It might also be the key to solving problems in the dementia care labour market. Considering health-care workers as precious capital and taking adequate measures to enhance job satisfaction might contribute to a better image of dementia care. The following hypothesis has been derived from our results: enhancement of job satisfaction will prevent professional caregivers from quitting jobs and improve the quality of care and patient outcomes.     

Job demands and dementia risk among male twin pairs

BackgroundJob characteristics may influence risk of dementia, but some types of job complexity remain to be examined. Twin studies provide a useful methodology for examining job differences between pairs who share many environmental and genetic influences.MethodsMembers of the National Academy of Sciences-National Research Council’s Twins Registry of World War II Veterans received a clinical evaluation for dementia and job ratings from the Dictionary of Occupational Titles.ResultsCo-twin control models (n = 220 pairs) indicated lower risk of dementia with greater job demands of reasoning, mathematics, language, and vocational training, with comparable results in case-control models (n = 425 cases). These effects were significant among twin pairs discordant for ≥6 years, but not among those discordant between 3–5 years. Results were similar for Alzheimer’s disease, and the main effects were not further explained by zygosity or apolipoprotein E genotype.ConclusionsJobs that utilize data, academic skills, and extensive vocational training may protect against dementia. However, in twin pairs, these effects only emerged among individuals who remained free of dementia several years after onset in their sibling.     

Maternal exposure to psychosocial job strain during pregnancy and behavioral problems in the 11-year-old children: a Danish cohort study

Maternal psychosocial stress may impact child neurodevelopment, but little is known regarding psychosocial job strain. We hypothesized high psychosocial job strain during pregnancy was associated with behavioural problems in the 11-year-old children. Mothers in the Danish National Birth Cohort (1996–2002) were included if they worked, provided information on job strain [Karasek’s model: high job strain (often job demand/seldom job control) and passive (seldom or sometimes job demands/seldom job control)] during early pregnancy. At the 11-year follow-up, children (N = 30,592), mothers (N = 30,993), and teachers (N = 12,810) responded to the Strength and Difficulties Questionnaire (SDQ), a screening tool for child behaviour. Scores for hyperactivity, conduct, emotional and peer problems were dichotomised [80% (no) vs. 20% (yes)] according to Danish norms (yes/no). Maternal job strain was not associated with behavioural problems with teachers as informants. When assessed by child or mother, high maternal job strain increased risk of child behavioural problems, but risks were more pronounced for mothers in passive jobs [maternal assessment of total difficulties/odds ratio (95% confidence interval): high strain—girls: 1.16 (0.97–1.40); boys: 1.24 (1.02–1.50). Passive girls: 1.43 (1.21–1.68); boys: 1.25 (1.05–1.49)]. This is one of the first studies on this topic. The different types of maternal job strain were partly associated with child behavioural problems at 11 years; more so if mothers worked in passive rather than the hypothesized high strain jobs. Findings showing dependency on informant could not only indicate unmeasured confounding or rater’s bias, but also selection in the smaller numbers of teacher informants or different environments of interaction with the children.

     

Endocrinological and psychological responses to job stressors: an experimental test of the job demand--control model

The buffer hypothesis of the Job Demand-Control Model predicts that high levels of job control compensate for the negative effects of high job demands on well-being and health. Several studies have tested this hypothesis, but the results are far from consistent. The objective of this study was to test the buffer hypothesis with respect to psychological (subjective well-being) and physiological (salivary cortisol) indicators of job strain, using an experimental study design. Seventy-seven men and women worked at a simulated computer workplace for more than two hours. Job demands and job control were manipulated in a 2 (job demands: high vs. low)×2 (job control: high vs. low)×7 (time of measurement) study design. Demands were operationalized in terms of workload, and pacing control (self-paced vs. machine-paced) was used as a job control manipulation. As dependent variables, subjective well-being and salivary cortisol were measured at seven time points during the experiment (T1-T7). In line with the buffer hypothesis, high control eliminated the impact of high demands on salivary cortisol responses. The hypothesis was supported by a predicted significant three-way interaction of demands, control and time of measurement (p<.001), qualified by the absence of significant effects of the independent variables at T1 and T2 due to lagged cortisol reactions, and significant two-way interactions of demands and control, as predicted by the model, at the five remaining times of measurement (T3-T7): high demands led to increased cortisol reactions only in the low control condition. In contrast, no main or interaction effects of the independent variables were found for subjective well-being. This discrepancy between physiological and psychological stress reactions might be due to the lack of specificity inherent in measures of subjective well-being, due to lagged psychological reactions, or due to self-report biases in the subjective measures. In sum, this study provides the first clear-cut experimental evidence for the idea that the negative impact of high job demands on endocrinological responses can be buffered by high levels of job control.     

The impact of the COVID-19 pandemic on blood pressure control after a stroke or transient ischemic attack among patients at VA medical centers

ObjectiveTo study factors associated with systolic blood pressure(SBP) control for patients post-discharge from an ischemic stroke or transient ischemic attack(TIA) during the early months of the COVID-19 pandemic compared to pre-pandemic periods within the Veterans Health Administration(VHA).Materials and MethodsWe analyzed retrospective data from patients discharged from Emergency Departments or inpatient admissions after an ischemic stroke or TIA. Cohorts consisted of 2,816 patients during March–September 2020 and 11,900 during the same months in 2017-2019. Outcomes included primary care or neurology clinic visits, recorded blood pressure readings and average blood pressure control in the 90-days post-discharge. Random effect logit models were used to compare clinical characteristics of the cohorts and relationships between patient characteristics and outcomes.ResultsThe majority (73%) of patients with recorded readings during the COVID-19 period had a mean post-discharge SBP within goal (<140 mmHg); this was slightly lower than the pre-COVID-19 period (78%; p=0.001). Only 38% of the COVID-19 cohort had a recorded SBP in the 90-days post-discharge compared with 83% of patients during the pre-pandemic period (p=0.001). During the pandemic period, 29% did not have follow-up primary care or neurologist visits, and 33% had a phone or video visit without a recorded SBP reading.ConclusionsPatients with an acute cerebrovascular event during the initial COVID-19 period were less likely to have outpatient visits or blood pressure measurements than during the pre-pandemic period; patients with uncontrolled SBP should be targeted for follow-up hypertension management.     

Exercise outcomes in prevalent users of stimulant medications

BackgroundTo compare users of stimulant medications with matched nonusers on exercise outcomes during a maximal treadmill exercise test.MethodsA cross-sectional study of a community-based cohort comparing propensity-score-matched stimulant medication users (n = 245) and nonusers (n = 735) who underwent a maximal treadmill exercise test in the Cooper Center Longitudinal Study cohort from January 1, 1995 to December 31, 2013. Main Outcomes were peak systolic blood pressure (SBP), average rise in SBP, peak heart rate (HR), and estimated VO₂max during exercise. A linear mixed model analysis was used to evaluate the effect of stimulant exposure on each of the exercise outcomes. In a sensitivity analysis, users were compared against nonusers for risk of chronotropic incompetence. Analyses were adjusted for relevant covariates and multiple testing.ResultsPeak HR during exercise was significantly lower in stimulant medication users (least square mean estimate 170.2 beats/minute) compared to nonusers (174.4 beats/minute; p < 0.0001). Moreover, stimulant medication users had an increased risk of chronotropic incompetence compared to nonusers (adjusted odds ratio 3.28, 95% confidence interval 1.70 to 6.34, p = 0.0008). No significant differences were observed in the outcomes of peak SBP, average SBP rise, and estimated VO₂max between matched groups.ConclusionsStimulant medication use was associated with a significant decrease in peak HR and an increased risk of chronotropic incompetence. Further investigation is required to understand the clinical significance of chronotropic incompetence in stimulant medication users. Concerns that stimulant medication use may increase peak SBP and average SBP during exercise were not supported by this study.     

The impact of perceived hypertension status on anxiety and the white coat effect

Background: The white coat effect can lead to overdiagnosis of hypertension and unnecessary pharmacologic treatment. Mechanisms underlying the white coat effect remain poorly understood but are critical to improving the accuracy of clinic blood pressure measurement.Purpose: This study investigated whether perceived hypertension status was associated with state anxiety levels during a clinic visit and the magnitude of the white coat effect, independent of true blood pressure status.Methods: This observational study included 214 normotensive and mildly hypertensive participants who were 18 to 80 years old, had no cardiac history, and were willing to discontinue antihypertensive medications for 8 weeks. Participants underwent 36 hr ambulatory blood pressure monitoring and physician blood pressure measurement. Outcome measures were state anxiety reported during the clinic visit and the white coat effect.Results: An analysis of covariance indicated that participants who perceived themselves as hypertensive reported greater state anxiety (p<.001) and showed larger white coat effects (ps<.01) compared with those who perceived themselves as normotensive. True hypertension status based on ambulatory blood pressure was not related to either outcome. Anxiety accounted for approximately 19% of the association between perceived hypertension status and the white coat effect.Conclusions: These findings suggest that the perception of being hypertensive is associated with greater anxiety during clinic blood pressure measurement and a larger white coat effect, independent of the true blood pressure level. Anxiety appears to be a mechanism by which perceived hypertension status contributes to the white coat effect. Preparation of this article was supported in part by the National Heart, Lung, and Blood Institute, National Institutes of Health, Grants HL47540 and HL76857, T. G. Pickering, Principal Investigator. The sponsors had no role in the study design; in the collection, analysis, or interpretation of the data; in the writing of this article; or in the decision to submit the article for publication.