Lower socioeconomic status among men in relation to the association between job strain and blood pressure

OBJECTIVES: This study attempted to determine whether the association between job strain (high job demands plus low job control) and blood pressure among men varies by socioeconomic status. METHODS: The cross-sectional associations between job strain and ambulatory blood pressure, by level of education, occupational status, and income, and the interaction between job strain and these measures of socioeconomic status were assessed by multiple linear regression, adjusted for age, race or ethnicity, body mass index, alcohol use, smoking, standing position, and worksite for 283 men, aged 30-60 years, from eight worksites in New York City. RESULTS: A substantial association between job strain and work ambulatory blood pressure was found among men with lower socioeconomic status, ranging from 2.7-11.8 mm Hg systolic to 1.9-6.1 mm Hg diastolic blood pressure, depending upon the measure of socioeconomic status examined. However, in the groups with high socioeconomic status, the association between job strain and ambulatory blood pressure at work was much smaller, the range in blood pressure being 0-5.3 (systolic) and 0.2-2.1 (diastolic) mm Hg. Two of the 10 tests of the interaction between job strain and socioeconomic status had a P-value of <0.05. CONCLUSIONS: These data provide evidence that the relationship between job strain and blood pressure is greater among men with lower socioeconomic status.     

Blood pressure and risk of renal cell carcinoma in the European prospective investigation into cancer and nutrition

Elevated blood pressure has been implicated as a risk factor for renal cell carcinoma (RCC), but prospective studies were confined to men and did not consider the effect of antihypertensive medication. The authors examined the relation among blood pressure, antihypertensive medication, and RCC in the European Prospective Investigation into Cancer and Nutrition (EPIC). Blood pressure was measured in 296,638 women and men, recruited in eight European countries during 1992-1998, 254,935 of whom provided information on antihypertensive medication. During a mean follow-up of 6.2 years, 250 cases of RCC were identified. Blood pressure was independently associated with risk of RCC. The relative risks for the highest versus the lowest category of systolic (>/=160 mmHg vs. <120 mmHg) and diastolic (>/=100 mmHg vs. <80 mmHg) blood pressures were 2.48 (95% confidence interval: 1.53, 4.02) and 2.34 (95% confidence interval: 1.54, 3.55). Risk estimates did not significantly differ according to sex or use of antihypertensive medication. Individuals taking antihypertensive drugs were not at a significantly increased risk unless blood pressure was poorly controlled. These results support the hypothesis that hypertension, rather than its medications, increases the risk of RCC in both sexes, while effective blood pressure control may lower the risk.     

Birth size, growth, and blood pressure between the ages of 7 and 26 years: failure to support the fetal origins hypothesis

The "fetal origins hypothesis" asserts that birth weight is inversely related to later blood pressure. Data from a cohort of 891 infants born in Dunedin, New Zealand, in 1972-1973 whose blood pressure was measured at 2-year intervals from age 7 years to age 15 years and at ages 18 and 26 years were used to test this hypothesis. Three regression models based on standardized scores for weight and height were used. The first showed that at any of the ages at which the cohort was assessed, an increase in birth weight of one z score (one standard deviation) was commensurate with a decrease of 0.29 mmHg (95% confidence interval: -0.17, 0.76) in blood pressure. The second model showed that a one-z-score increase in weight between birth and a subsequent age was associated with an increase in systolic blood pressure of 0.96 mmHg (95% confidence interval: 0.53, 1.38). This estimate applied to all ages. The third model showed that the effect of an interaction between birth weight and later weight was not significant; thus, there was no evidence to suggest that children with a low birth weight who became overweight or obese had extra high blood pressure. Similar results were obtained for height. These results fail to support the fetal origins hypothesis.     

Isolated systolic hypertension in Dutch middle aged and all-cause mortality: a 25-year prospective study

In the early 1950s, the blood pressure of 3901 Dutch civil servants and their spouses aged 40-65 years was measured in a general health survey. Isolated systolic hypertension (systolic pressure greater than 160 mmHg, diastolic pressure less than 90 mmHg) was observed in 6.3% of the women and 3.0% of the men. The prevalence increased with age and it was more common in women in all age groups. Using logistic regression, with adjustment for potential confounders (age, smoking, serum cholesterol, Quetelet index, alcohol consumption, haemoglobin level, pulse rate and diastolic blood pressure) the association of 15- and 25-year total mortality with isolated systolic hypertension was determined. Compared to normotensive people (systolic pressure less than or equal to 135 mmHg, diastolic pressure less than 90 mmHg), the risk of death from all causes was significantly higher for men with isolated systolic hypertension after 15 and 25 years of follow-up (odds ratio OR = 2.4, 95% confidence interval (CI) 1.2-4.8 and OR = 3.2, 95% CI 1.3-8.0). For women 15-years mortality risk was strongly associated with isolated systolic hypertension (OR = 3.7, 95% CI 1.4-9.7). The increased risk was less pronounced after 25 years of follow-up (OR = 1.7, 95% CI 0.96-3.0). Our results support those of other studies and indicate that isolated systolic hypertension is an important independent risk factor for all-cause mortality. Since isolated systolic hypertension may be an indicator for the early onset of ageing, it is important to study its determinants and to pay more attention to its diagnosis and treatment in middle-aged populations.     

Adult blood pressure and climate conditions in infancy: a test of the hypothesis that dehydration in infancy is associated with higher adult blood pressure

The authors hypothesized that individuals born in the early 20th century who experienced the hottest and driest summers during infancy would be more likely to have suffered severe infant diarrhea and dehydration, and consequently have had higher blood pressure in adulthood, than those who experienced cooler and wetter summers. In this context, these climate data act as an instrumental variable for the association of early-life dehydration with later blood pressure. For 3,964 randomly selected British women born between 1919 and 1940 and whose blood pressure was measured at age 60-79 years, a one standard deviation (1.3 degrees C) higher mean summer temperature in the first year of life was associated with a 1.12-mmHg (95% confidence interval: 0.33, 1.91) higher adult systolic blood pressure, and a one standard deviation higher mean summer rainfall (33.9 mm) was associated with lower systolic blood pressure (-1.65 mmHg, 95% confidence interval: -2.44, -0.85). Equivalent results for diastolic blood pressure were 0.11 (95% confidence interval: -0.65, 0.86) and -0.32 (95% confidence interval: -0.71, 0.05). The climate variables were not associated with potential confounding factors such as socioeconomic position or lifestyle risk factors. These findings provide some evidence in favor of the hypothesis that dehydration in infancy is associated with higher adult blood pressure.     

Job strain and arteriosclerosis in three different types of arteries among male Japanese factory workers

OBJECTIVES: This study evaluated the association between job strain and subclinical indicators of arteriosclerosis simultaneously in the cerebral artery, the aorta, and the carotid artery. METHODS: The participants in this cross-sectional study consisted of 352 male factory workers between the ages of 24.9 to 55.8 (mean 41.7) years who had not been exposed to any hazardous chemicals in Japan. Job strain was measured using a Japanese version of the Job Content Questionnaire developed by Karasek. The following subclinical indicators of arteriosclerosis were examined by noninvasive procedures: hyperintense spots in T2-weighted images in brain magnetic resonance imaging (MRI), pulse wave velocity of the aorta, and the stiffness parameter of the carotid artery using ultrasound and systolic and diastolic blood pressure. RESULTS: After control for potential confounders, high job strain was associated with an increased prevalence of hyperintense spots (adjusted odds ratio 2.53, 95% confidence interval 1.14-5.63), and elevated pulse-wave velocity (adjusted increase in percent 3.5, 95% confidence interval 0.0-6.9). The stiffness parameter tended to be elevated in the high job-strain group although this trend was not statistically significant. Job strain showed no relation to blood pressure. CONCLUSIONS: In this study, job strain was associated with subclinical indicators of arteriosclerosis in different arteries although the association was not statistically significant for the carotid artery. New information is offered by brain MRI for arteriosclerosis in the cerebral artery. An increase in hyperintense spots may explain the link between job strain and cerebrovascular disease.     

The association of birth weight with developmental trends in blood pressure from childhood through mid-adulthood: the Bogalusa Heart study

Low birth weight has been found to be associated with cardiovascular mortality and morbidity and with an adverse profile of several cardiovascular risk factors. The inverse association between birth weight and blood pressure was consistently reported from many populations. Using longitudinal data from the Bogalusa Heart Study (Louisiana), the authors investigated the association between birth weight and progression of blood pressure through early adulthood, comparing that relation between African Americans and Whites. Birth data of 2,275 participants, screened two or more times in the Bogalusa Heart Study between 1973 and 2001, were retrospectively obtained from birth certificates and were linked to their clinical, laboratory, and socioeconomic and lifestyle data in the Bogalusa Heart Study data sets. Birth weight was inversely associated with systolic blood pressure, diastolic blood pressure, and pulse pressure (p相似文献   

Increases in hypertension and blood pressure during pregnancy with increased bone lead levels

Prior studies have revealed associations of current lead exposure (blood lead) and past lead exposure (bone lead) with risks of hypertension and elevated blood pressure. The authors examined the effects of blood and bone lead on hypertension and elevated blood pressure in the third trimester and postpartum among 1,006 women enrolled in Los Angeles prenatal care clinics between 1995 and 2001. The authors measured bone lead concentration by K-shell x-ray fluorescence in the tibia (mean = 8.0 micro g/g (standard deviation (SD) 11.4)) and calcaneus (heel) (mean = 10.7 micro g/g (SD 11.9)). Geometric mean prenatal and postnatal blood lead levels were 1.9 micro g/dl (geometric SD +3.6/-1.0) and 2.3 micro g/dl (geometric SD +4.3/-1.2), respectively. For each 10- micro g/g increase in calcaneus bone lead level, the odds ratio for third-trimester hypertension (systolic blood pressure > or =140 mmHg or diastolic blood pressure > or =90 mmHg) was 1.86 (95% confidence interval (CI): 1.04, 3.32). In normotensive subjects, each 10- micro g/g increase in calcaneus bone lead level was associated with a 0.70-mmHg (95% CI: 0.04, 1.36) increase in third-trimester systolic blood pressure and a 0.54-mmHg (95% CI: 0.01, 1.08) increase in diastolic blood pressure. Tibia bone lead concentration was not related to hypertension or elevated blood pressure either in the third trimester or postpartum, nor was calcaneus bone lead related to postpartum hypertension or elevated blood pressure. Past lead exposure influences hypertension and elevated blood pressure during pregnancy. Controlling blood pressure may require reduction of lead exposure long before pregnancy.     

Heart rate, employment status, and prevalent ischaemic heart disease confound relation between cereal fibre intake and blood pressure.

Cross sectional data from a survey of 2512 men aged 45-49 years were used to examine the confounding effects of heart rate, employment, and ischaemic heart disease (IHD) on the relation between cereal fibre intake and blood pressure. Daily cereal fibre intake (g/day) was associated with systolic pressure (r = -0.053, p less than 0.01), diastolic pressure (r = -0.057, p less than 0.01), and heart rate (r = -0.071, p less than 0.01). The associations were strengthened in employed men and inapparent in unemployed men. Unemployed men had more IHD than employed men. Persons with any manifestation of IHD had significantly higher blood pressure and heart rates but ate less cereal fibre (7.0 v 7.9 g/day, p less than 0.001) than those without IHD, regardless of employment status. In employed men, after adjustment for age, body mass index, prevalent IHD, and heart rate, systolic pressure changed -0.186 mmHg (95% CI = -0.362, -0.009) and diastolic pressure changed -0.111 mmHg (95% CI = 0.228, 0.005) for each gram of cereal fibre eaten daily. The association between cereal fibre and blood pressure was inapparent in unemployed men. Heart rate, employment, and prevalent IHD confound the association between cereal fibre intake and blood pressure. Future work concerning this relationship will have to account for the effects of these variables.     

Does job strain increase the risk for coronary heart disease or death in men and women? The Framingham Offspring Study

Conflicting findings in the literature have made the relation between job strain and coronary heart disease (CHD) controversial. The effect of high job strain on the 10-year incidence of CHD and total mortality was examined in men and women participating in the Framingham Offspring Study; 3,039 participants, 1,711 men and 1,328 women, aged 18-77 years, were examined between 1984 and 1987 and followed for 10 years. Measures of job strain, occupational characteristics, and risk factors for CHD were collected at the baseline examination. Before and after controlling for systolic blood pressure, body mass index, cigarette smoking, diabetes, and the total/high density lipoprotein cholesterol ratio in Cox proportional hazards models, the authors found that high job strain was not associated with mortality or incident CHD in either men or women over the follow-up period. Contrary to expectation, women with active job strain (high demands-high control) had a 2.8-fold increased risk of CHD (95% confidence interval: 1.1, 7.2) compared with women with high job strain (high demands-low control). For men, higher education, personal income, and occupational prestige were related to decreased risk of total mortality and CHD. These findings do not support high job strain as a significant risk factor for CHD or death in men or women.     

Job strain, social support at work, and incidence of myocardial infarction

OBJECTIVES: The combination of high psychological job demands and low decision latitude (high job strain) has been associated with an increased risk of coronary heart disease. It has been proposed that this may also be the case for low social support at work. The aim of this study was to analyse the relations between these psychosocial factors and incidence of myocardial infarction. METHODS: Associations between psychosocial work characteristics and incidence of myocardial infarction was investigated through a population based case-control study. The study base comprised employed men and women in five Swedish counties during the years 1976-84. Cases of first myocardial infarction were identified from hospital discharge registers and death records from outside hospital, controls were selected through a random sample, and psychosocial work environment was assessed through a job exposure matrix on the basis of the occupation in the 1970 and 1975 censuses. RESULTS: An increased incidence of myocardial infarction was found for men and women in occupations characterised by low decision latitude. For men this increase was seen primarily in combination with high psychological demands (high job strain) and low social support at work. Younger men (30-54 years of age) in occupations with both high job strain and low social support at work had a relative risk of 1.79 (95% confidence interval (95% CI) 1.22 to 2.65) compared with subjects in low strain and high social support jobs after controlling for age, county of residence, and socioeconomic group. CONCLUSIONS: Our results indicate that jobs characterised by low decision latitude, high job strain, or low social support at work may be associated with an increased risk of acute myocardial infarction. If these associations are causal they may be of substantial importance from the point of view of workers' health.

 

     

Shift work, occupational noise and physical workload with ensuing development of blood pressure and their joint effect on the risk of coronary heart disease

OBJECTIVES: The change in systolic blood pressure (SBP) over an 8-year period was explored in groups defined according to exposure to shift work, occupational noise, and physical workload. The impact of baseline SBP and its increase in relation to coronary heart disease (CHD) risk due to these exposures was also studied. METHODS: The study cohorts (N=1288 for CHD follow-up, N=884 for SBP follow-up) consisted of industrially employed middle-aged men from the Helsinki Heart Study. Shiftwork status was obtained from a questionnaire, and other exposures were determined with the Finnish job-exposure matrix. SBP was measured in the Helsinki Heart Study, and CHD end points were obtained from official Finnish registers. The joint effects of baseline SBP, its change, and the exposure in question were estimated via Cox s regression models. RESULTS: During the SBP follow-up, the steepest SBP gradient was found for physical workload only and physical workload combined with noise; shift work alone or combined with noise primarily entailed a lower mean SBP level than no such exposure. However, the shift workers had a relative risk of 1.71 [95% confidence interval (95% CI) 1.01-2.87] even without an increase in SBP, but, with a baseline SBP of > or = 140 mmHg and an additional increase, their relative risk rose to 4.62 (95% CI 2.31-9.24) when they were compared with day workers with an SBP of <140 mmHg and no increase. CONCLUSIONS: In general, shift workers do not develop higher SBP levels than day workers, but, if they do, it entails high CHD risk. Noise shows a similar pattern. In contrast, physical workload entails a significant increase in SBP, and SBP is a key pathway to CHD risk.     

A population-based longitudinal study on work environmental factors and the risk of major depressive disorder

To investigate the relation between work environmental factors and the risk of major depressive disorder (MDD) over 1 year, the authors conducted a population-based longitudinal study of randomly selected employees in Alberta, Canada (January 2008 to November 2011). Participants without a current or lifetime diagnosis of MDD at baseline (n = 2,752) were followed for 1 year. MDD was assessed using the World Health Organization's Composite International Diagnostic Interview-Auto 2.1. The overall 1-year incidence of MDD was 3.6% (95% confidence interval: 2.8, 4.6); it was 2.9% (95% confidence interval: 1.9, 4.2) in men and 4.5% (95% confidence interval: 3.3, 6.2) in women. The relations between work environmental factors and MDD differed by sex. In men, high job strain increased the risk of MDD in those who worked 35-40 hours per week; job insecurity and family-to-work conflict were predictive of MDD. Women who worked 35-40 hours per week and reported job insecurity, a high effort-reward imbalance, and work-to-family conflict were at a higher risk of developing MDD. Job strain, effort-reward imbalance, job insecurity, and work-to-family conflicts are important risk factors for the onset of MDD and should be targets of primary prevention. However, these work environmental factors appear to operate differently in men and in women.     

Blood pressure in relation to birth weight in twins and singleton controls matched for gestational age

Associations between adult blood pressure and birth weight were investigated in 122 same-sex twin pairs aged 18-50 years and 86 singleton controls matched according to maternal age and parity, gender, gestational age, and current age who were recruited via an obstetric database in Aberdeen, Scotland, in 1999. Twins weighed on average 425 g less than controls at birth (p < 0.001) but did not differ significantly in adult height or systolic or diastolic blood pressure from the controls. Among controls, the differences in systolic and diastolic blood pressure per kg of difference in birth weight, adjusted for gender, gestational age, current age, body mass index, smoking, physical activity level, and alcohol intake, were -4.3 (95% confidence interval (CI): -12.8, 4.3) and -6.1 (95% CI: -10.8, -1.5) mmHg/kg, respectively. In unpaired analysis among all twins, the equivalent values were -0.1 (95% CI: -4.0, 3.8) mmHg/kg for systolic pressure and -0.4 (95% CI: -2.9, 2.2) mmHg/kg for diastolic pressure, while in within-pair analysis the values were -0.9 (95% CI: -6.4, 4.6) mmHg/kg for systolic pressure and -0.2 (95% CI: -4.1, 3.7) mmHg/kg for diastolic pressure. The results suggest that in-utero growth restriction in twins is not a major determinant of their blood pressure as adults.     

Exposure to a nutrition supplementation intervention in early childhood and risk factors for cardiovascular disease in adulthood: evidence from Guatemala

To study the role of nutrition in the association of birth size and childhood growth with development of cardiovascular disease, the authors in 2002-2004 surveyed 665 men and 790 women aged 25-42 years who had been exposed as children to a community-randomized nutrition supplementation intervention in four villages in eastern Guatemala. Exposure was associated with a lower fasting glucose level (7.0 mg/dl, 95% confidence interval (CI): 0.5, 13.5) for exposure at ages 36-72 months; lower systolic blood pressure (3.0 mmHg, 95% CI: 0.4, 5.6) for exposure at ages 24-60 months; and a lower triglyceride level (sex-adjusted; 22.2 mg/dl, 95% CI: 0.4, 44.1) and higher high density lipoprotein cholesterol level (males only; 4.7 mg/dl, 95% CI: 1.5, 7.9) for exposure prior to age 36 months. Improved nutrition at any age prior to 7 years was not associated with diastolic blood pressure, total or low density lipoprotein cholesterol level, or prevalence of the metabolic syndrome. Interventions designed to address nutrient deficiencies and ameliorate stunting that are targeted at pregnant women and young children are unlikely to increase cardiovascular disease risk later in life and may instead lower the risk.     

Homocysteine and blood pressure in the Third National Health and Nutrition Examination Survey, 1988-1994

Studies suggest that homocysteine may elevate blood pressure and increase the risk of hypertension. The association of homocysteine with blood pressure and with the risk of hypertension was investigated using cross-sectional data from the Third National Health and Nutrition Examination Survey (1998-1994). Homocysteine had an independent positive association with blood pressure after adjusting for cardiovascular risk factors. A 1 standard deviation ( approximately 5 micro mol/liter) increase in homocysteine was associated with increases in diastolic and systolic blood pressure of 0.5 and 0.7 mmHg, respectively, in men and of 0.7 and 1.2 mmHg in women. Similarly, higher levels of homocysteine were associated with an increased risk of hypertension. In a comparison of the highest and lowest quintiles of homocysteine, women had a threefold increase in the risk of hypertension (95% confidence interval (CI): 1.7, 5.4), and men had a twofold increase (95% CI: 0.7, 5.1). In light of the homocysteine-blood pressure association, the association of homocysteine with prevalent cardiovascular disease was examined with and without adjusting for blood pressure. The results support a mediating role for blood pressure in women and suggest that the full effect of homocysteine on cardiovascular risk may be underestimated when blood pressure is adjusted.     

Nurse-led adherence support in hypertension: a randomized controlled trial

BACKGROUND: Lack of medication adherence is a common reason for poor control of blood pressure in the community, increasing the risk of heart attacks and strokes. OBJECTIVE: To evaluate the effect of nurse-led adherence support for people with uncontrolled high blood pressure compared with usual care. METHODS: We recruited 245 women and men with uncontrolled hypertension (> or = 150/90 mmHg) from 21 general practices in Bristol, UK. Participants were randomized to receive nurse-led adherence support or usual care alone. Main outcome measures were adherence to medication ('timing compliance') and blood pressure. RESULTS: Mean baseline timing compliance (+/- SD) was high in both the intervention (90.8 +/- 15.6%) and the control group (94.5 +/- 7.6%). There was no evidence of an effect of the intervention on timing compliance at follow-up (adjusted difference in means -1.0%; 95% confidence interval (CI) -5.1 to 3.1). There was also no difference at follow-up between the groups with regard to systolic blood pressure (-2.7 mmHg; 95% CI -7.2 to 1.8) or diastolic blood pressure (0.2 mmHg; 95% CI -1.9 to 2.3). Projected costs for the primary care sector per consultation were 6.60 pound sterling for the intervention compared with 5.08 pound sterling for usual care. CONCLUSION: In this study, adherence to blood pressure medication was much higher than previously reported. There was no evidence of an effect of nurse-led adherence support on medication adherence or blood pressure compared with usual care. Nurse-led adherence support was also more expensive from a primary care perspective.     

Is there a sex difference in the association between birth weight and systolic blood pressure in later life? Findings from a meta-regression analysis

The aim of this study was to determine whether a sex difference exists in the association between birth weight and systolic blood pressure. A meta-analysis of all observational studies (n = 57) in which the study population contained both males and females and the association between birth weight and blood pressure was presented as a linear regression coefficient was undertaken. There were no differences in the pooled regression coefficients between males and females combining all studies; the regression of blood pressure on birth weight for males was -1.27 (95% confidence interval: -1.77, -0.77) mmHg/kg and for females was -1.24 (95% confidence interval: -1.90, -0.58) mmHg/kg. When studies in which blood pressure had been measured in childhood were considered separately from those in which it was measured in adulthood, there were no sex differences in either age group. The pooled regression coefficient tended to be weaker in studies reporting sex-specific results than in those reporting combined results. These findings suggest that reports of sex differences in the association between birth weight and blood pressure are chance findings.     

Blood pressure,smoking, and the incidence of lung cancer in hypertensive men in North Karelia,Finland

Few studies have suggested that elevated blood pressure might be associated with increased risk of lung cancer and that this association might vary according to smoking status. The aim of this study was to assess the effect of blood pressure and its possible interaction with smoking on lung cancer incidence in hypertensive patients. Lung cancer incidence was determined for 7,908 men enrolled in the hypertension register of the North Karelia Project between 1972 and 1988 by record linkage to the nationwide Finnish Cancer Registry. In a Cox regression model, both systolic and diastolic blood pressures were significant predictors of lung cancer, with a 10% increase in risk per 10-mmHg increment in blood pressure. In smokers, the age-adjusted hazard ratio associated with a 10-mmHg increment in diastolic blood pressure was 1.17 (95% confidence interval: 1.05, 1.29), and in nonsmokers it was 0.98 (95% confidence interval: 0.80, 1.16). For systolic blood pressure, these hazard ratios were 1.11 (95% confidence interval: 1.05, 1.17) for smokers and 1.04 (95% confidence interval: 0.95, 1.14) for nonsmokers. These findings suggest that high blood pressure levels are associated with increased risk of lung cancer in smoking, hypertensive men.