Job Control and Ambulatory Blood Pressure

By Mc Carthy, Vera J. C.; Perry, Ivan J. et al. | Scandinavian Journal of Work, Environment & Health, September 1, 2014 | Go to article overview

Job Control and Ambulatory Blood Pressure


Mc Carthy, Vera J. C., Perry, Ivan J., Greiner, Birgit A., Scandinavian Journal of Work, Environment & Health


Work stress has been found to account for a proportion of coronary heart disease (CHD) events in workers (1). Hypertension, although perhaps not the principal pathway between job strain (high job demands and low job control) and CHD, is a preventable risk factor (2), and chronic stress has been acknowledged as a credible cause of high blood pressure (BP) (3). Some recent meta-analyses have concluded that job strain is a risk factor for hypertension (4-6) but others failed to find an association (7). Additionally, the reduction in BP from day- to night-time is of importance. However, further investigations into job strain and nocturnal BP dipping and potential modifiers of this effect are required (4).

High job control has been reported as a relevant positive factor in BP presentation. Workers with low job control have been found to have higher BP than those with high job control (6, 8). However, inconsistent associations have been found between this exposure and outcome. For instance, only half of the relevant studies reviewed by Gilbert-Ouimet et al (6) showed a significant protective effect for high job control. Furthermore, job control is beneficial to nocturnal systolic BP (SBP) dipping (9), an important physiological function (10, 11) as night-time BP is a compelling predictor of cardiovascular mortality (12). Nocturnal SBP dipping is in line with contemporary stress theory, specifically the allostatic model. This model hypothesizes that the body copes with the stresses put on it by the activation of bodily systems and recovers when the stresses cease (13, 14). Stressors at work can increase allostatic load particularly when the demand on the individual carries on for some time. For example, BP may elevate at work in response to activation (stressor). However, for the body to recover there should be a corresponding reduction of BP at rest.

Researchers have found that hypertensive men with low job control had higher sleep SBP and lower SBP dipping compared to men with high job control (9). Inconsistent associations have been reported for job control and diastolic BP (DBP). High job control has been found to be associated with high DBP for females using casual BP readings (15), whereas other researchers using ambulatory BP monitoring (ABPM) readings found low job control to be associated with high DBP (8, 16).

Job control as defined by the demand-control model typically comprises two components: skill discretion (use/develop skills) and decision authority (autonomy/ authority over work) (17). Some scholars have found associations to vary for these components (18). This highlights the need to distinguish between the job control dimensions which are commonly collectively seen as beneficial. New job characteristic questionnaires specifically discriminate between the dimension of possibility for development and influence at work (Copenhagen Psychosocial Questionnaire, COPSOQ) (19). To date no investigation of these aspects of the COPSOQ and hypertension has been undertaken.

Research has found older workers to be more vulnerable to adverse work characteristics particularly with regard to physical health (20, 21). Workers >50 years who had a cardiac event were found to be more likely to have low job control whereas no association was found for younger workers (21). Although BP usually increases with age, older workers are thought to adapt to their work environment where control over their work has developed with time (13), but this may vary by social class. Little has been done to investigate job control (specifically) and BP in a sample of older workers. This study investigates the association of different components of job control with BP and BP dipping in a middle-aged Irish primary care-based sample using clinic and 24-hour ambulatory BP measurements. The objectives of this study are to: (i) examine the BP levels of the complete sample including workers and non-workers; (ii) explore the relationship of the job control dimensions with day- and night-time BP; and (iii) investigate nocturnal SBP dipping among workers while taking sociodemographics and lifestyle factors into account. …

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