A longitudinal study of job strain and ambulatory blood pressure: Results from a three-year follow-up

Objective: This study was conducted to investigate the hypothesis that exposure to "job strain" is related to increased ambulatory blood pressure (ABP). Method: Participants were 195 men who wore an ABP monitor for 24 hours on two occasions 3 years apart. Job strain status, evaluated at each assessment, was used to identify four groups: those not having job strain at either assessment (N = 138), those having job strain at both times (N = 15), and two crossover groups. Regression analysis was used to examine the cross-sectional associations of ABP with job strain, controlling for other known risk factors. Repeated-measures analysis of variance was used to examine the association of ABP change with the category of job strain change. Results: The cross-sectional analysis of the Time 2 data yielded almost identical, highly significant effects of job strain on ABP as was shown in our previously published Time 1 analysis. Those in high strain jobs at both times had systolic/diastolic ABPs at work and at home that were, on average, 11/7 mm Hg higher than those with no job strain at both times; the crossover groups had intermediate levels of ABP. The longitudinal analysis showed that those with a high strain job at Time 1, but not at Time 2, had a significant decrease in work and home ABP of approximately 5/3 mm Hg. Conclusions: The previously reported cross-sectional association between job strain and ABP was replicated at follow-up. The group repeatedly exposed to job strain had higher levels of ABP at Time 2 than either crossover group. Furthermore, change in job strain status partially predicted change in ABP. These results provide new evidence supporting the hypothesis that job strain is an occupational risk factor in the etiology of essential hypertension.