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The Role of Occupational Status in the Association Between Job Strain and Ambulatory Blood Pressure During Working and Nonworking Days.

ABSTRACT: OBJECTIVES:The objectives of this study were to determine whether job strain is more strongly associated with higher ambulatory blood pressure (ABP) among blue-collar workers compared with white-collar workers, to examine whether this pattern generalizes across working and nonworking days and across sex, and to examine whether this pattern is accounted for by psychosocial factors or health behaviors during daily life. METHODS:A total of 480 healthy workers (mean age = 43 years, 53% female) in the Adult Health and Behavior Project-Phase 2 completed ABP monitoring during 3 working days and 1 nonworking day. Job strain was operationalized as high psychological demand (> sample median) combined with low decision latitude (

SUBMITTER: Joseph NT

PROVIDER: S-EPMC5067969 | biostudies-literature | 2016 Oct

REPOSITORIES: biostudies-literature

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The Role of Occupational Status in the Association Between Job Strain and Ambulatory Blood Pressure During Working and Nonworking Days.

Joseph Nataria T NT Muldoon Matthew F MF Manuck Stephen B SB Matthews Karen A KA MacDonald Leslie A LA Grosch James J Kamarck Thomas W TW

Psychosomatic medicine 20161001 8

<h4>Objectives</h4>The objectives of this study were to determine whether job strain is more strongly associated with higher ambulatory blood pressure (ABP) among blue-collar workers compared with white-collar workers, to examine whether this pattern generalizes across working and nonworking days and across sex, and to examine whether this pattern is accounted for by psychosocial factors or health behaviors during daily life.<h4>Methods</h4>A total of 480 healthy workers (mean age = 43 years, 53 ...[more]

PMID: 27359177

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Project description:ImportanceBlood pressure (BP) is a known risk factor for overall mortality and cardiovascular (CV)-specific fatal and nonfatal outcomes. It is uncertain which BP index is most strongly associated with these outcomes.ObjectiveTo evaluate the association of BP indexes with death and a composite CV event.Design, setting, and participantsLongitudinal population-based cohort study of 11 135 adults from Europe, Asia, and South America with baseline observations collected from May 1988 to May 2010 (last follow-ups, August 2006-October 2016).ExposuresBlood pressure measured by an observer or an automated office machine; measured for 24 hours, during the day or the night; and the dipping ratio (nighttime divided by daytime readings).Main outcomes and measuresMultivariable-adjusted hazard ratios (HRs) expressed the risk of death or a CV event associated with BP increments of 20/10 mm Hg. Cardiovascular events included CV mortality combined with nonfatal coronary events, heart failure, and stroke. Improvement in model performance was assessed by the change in the area under the curve (AUC).ResultsAmong 11 135 participants (median age, 54.7 years, 49.3% women), 2836 participants died (18.5 per 1000 person-years) and 2049 (13.4 per 1000 person-years) experienced a CV event over a median of 13.8 years of follow-up. Both end points were significantly associated with all single systolic BP indexes (P < .001). For nighttime systolic BP level, the HR for total mortality was 1.23 (95% CI, 1.17-1.28) and for CV events, 1.36 (95% CI, 1.30-1.43). For the 24-hour systolic BP level, the HR for total mortality was 1.22 (95% CI, 1.16-1.28) and for CV events, 1.45 (95% CI, 1.37-1.54). With adjustment for any of the other systolic BP indexes, the associations of nighttime and 24-hour systolic BP with the primary outcomes remained statistically significant (HRs ranging from 1.17 [95% CI, 1.10-1.25] to 1.87 [95% CI, 1.62-2.16]). Base models that included single systolic BP indexes yielded an AUC of 0.83 for mortality and 0.84 for the CV outcomes. Adding 24-hour or nighttime systolic BP to base models that included other BP indexes resulted in incremental improvements in the AUC of 0.0013 to 0.0027 for mortality and 0.0031 to 0.0075 for the composite CV outcome. Adding any systolic BP index to models already including nighttime or 24-hour systolic BP did not significantly improve model performance. These findings were consistent for diastolic BP.Conclusions and relevanceIn this population-based cohort study, higher 24-hour and nighttime blood pressure measurements were significantly associated with greater risks of death and a composite CV outcome, even after adjusting for other office-based or ambulatory blood pressure measurements. Thus, 24-hour and nighttime blood pressure may be considered optimal measurements for estimating CV risk, although statistically, model improvement compared with other blood pressure indexes was small.

Dataset Information

The Role of Occupational Status in the Association Between Job Strain and Ambulatory Blood Pressure During Working and Nonworking Days.

Publications

The Role of Occupational Status in the Association Between Job Strain and Ambulatory Blood Pressure During Working and Nonworking Days.

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