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International Journal of Hypertension logoLink to International Journal of Hypertension
. 2025 Aug 27;2025:4794147. doi: 10.1155/ijhy/4794147

Analysis of Blood Pressure Status and Influencing Factors Among 7218 Emergency Department Nurses: An Observational Cross-Sectional Study

Wenjia Liu 1, Jie Liu 2, Jing Li 2, Ni Chen 1, Suzhi Zhang 1, Yufang Zhu 3, Yaping Wang 4, Xiaolin Zhang 5, XiaoRan Hao 6, Luqi Zhang 7, Yun Li 8, Bin Zhao 1,✉
PMCID: PMC12408129  PMID: 40909152

Abstract

Background: As frontline healthcare workers, emergency department nurses face high levels of urgency in their work and are exposed to a high risk of contingencies. Their blood pressure status and influencing factors require close attention.

Methods: This study employed a census method and conducted a cross-sectional survey in 11 cities in Hebei Province from November 2016 to July 2018, measuring blood pressure and collecting questionnaires on influencing factors. Binary logistic regression and multiple linear regression were used to analyze the factors influencing blood pressure. Multivariate analysis of variance was used to examine the interaction effects between monthly night shift frequency and other influencing factors on the blood pressure of emergency department nurses.

Results: A total of 7218 emergency department nurses in Hebei Province were included (median [IQR] age, 29 [8] years; 6038 [83.65%] women). The prevalence of hypertension was 9.43%. The median SBP (M [IQR]) was 112.0 (13) mmHg, and the median DBP was 70.0 (14) mmHg. Analysis showed that gender, age, BMI, marital status, hospital location, monthly night shift frequency, hyperlipidemia, and antihypertensive medication were influencing factors for the blood pressure (p < 0.05). Significant interactions existed between monthly night shift frequency and marital status, monthly night shift frequency and hospital grade, and monthly night shift frequency and hyperlipidemia (p < 0.05). The systolic blood pressure of emergency department nurses who were divorced or widowed or in Class I hospitals or hyperlipidemia increased to a high degree with the increase of night shifts. The diastolic blood pressure of those combined with hyperlipidemia increased higher with the rise of night shifts.

Conclusion: The blood pressure of emergency department nurses requires attention. Nursing managers should pay particular attention to nurses in the emergency department who are prone to hypertension and take proactive measures to prevent and manage hypertension.

Keywords: emergency department nurses, Hebei Province, hypertension, influencing factors, interactions, prevalence

1. Background

The emergency department serves as the initial point of care for critically ill patients and a central hub in the regional emergency response network. Its efficient operation directly impacts the healthcare system's emergency response capabilities. Emergency department nurses, as the frontline of this critical process, are responsible for pre-hospital emergency care, emergency observation, and resuscitation. They must promptly identify and accurately assess patients' complex conditions, rapidly initiate and efficiently execute emergency resuscitation measures, and secure the critical time window for subsequent diagnostic and therapeutic interventions [1]. However, high patient volumes and shortages of emergency department nurses have led to increased workloads, intense work rhythms, and extended working hours [2]. According to surveys, the average number of beds in the emergency departments of tertiary hospitals in China is 67, with daily patient volumes reaching up to 750, resulting in workloads for emergency department nurses that can be 2∼3 times higher than those of nurses in general wards [3]. Related studies indicate that these factors can lead to sympathetic nervous system excitation and increased catecholamine secretion, inevitably affecting blood pressure [4].

However, there is limited information on blood pressure among emergency department nurses, despite one study reporting that hypertension is relatively common among 606 Brazilian emergency department nurses [5]. Additionally, given the occupational specificity, the impact of work-related factors on blood pressure cannot be overlooked. Nevertheless, the factors influencing blood pressure in emergency department nurses identified in previous studies remain those recognized in guidelines, including age, race, body mass index (BMI), waist-to-hip ratio, and hyperlipidemia [6]. Night shifts, a common work pattern for emergency department nurses, have yet to be conclusively studied for their impact on blood pressure. Meanwhile, the interaction effects between the frequency of night shifts for emergency department nurses and other factors remain underreported. Given the objective existence of emergencies and nighttime patient needs, night shifts for emergency department nurses are unavoidable. Understanding the impact of night shifts is crucial for developing targeted hypertension prevention strategies.

Therefore, this study conducted a systematic and comprehensive survey of blood pressure among 7218 emergency department nurses, detailing the prevalence of hypertension and blood pressure levels among emergency department nurses, and exploring its influencing factors, including individual factors and work-related factors. Additionally, the study conducted a detailed analysis of the interaction effects between the frequency of night shifts among emergency department nurses and other blood pressure influencing factors, providing information to support scientific management, improve cardiovascular health levels, and enhance the quality and efficiency of emergency department nursing work.

2. Methods

2.1. Study Design and Population

The data for this study were obtained from a large cross-sectional survey conducted using a census method between November 2016 and July 2018. The survey covered all cities in Hebei Province, including Shijiazhuang City (including Xinji City), Baoding City (including Dingzhou City), Cangzhou City, Chengde City, Handan City, Hengshui City, Langfang City, Qinhuangdao City, Tangshan City, Xingtai City, and Zhangjiakou City, a total of 11 cities. Subsequently, a targeted analysis was conducted on the blood pressure status of emergency department nurses.

Inclusion criteria were defined as follows: ① registered nurses who were engaged in nursing work for ≥ 1 year and were currently working in the emergency department; ② age ≥ 18 years old; ③ no psychiatric diseases; and ④ informed consent and voluntary participation. Exclusion criteria were defined as follows: those on sick leave, maternity leave, and study leave.

2.2. Data Collection

2.2.1. Hypertension Influencing Factors

A questionnaire survey method: The questionnaire included ① general information (gender, age, height, weight, educational background, marital status, hospital location, hospital grade [according to the Hospital Classification and Management Standards]); ② monthly night shift frequency; ③ medical history information (whether suffering from hyperlipidemia or diabetes mellitus); ④ family history of hypertension; ⑤ antihypertensive medication; and ⑥ daily life history (smoking, alcohol consumption, and exercise).

Hypertension-related factors were reported online through a questionnaire.

2.2.2. Blood Pressure Measurement

Medical electronic sphygmomanometers certified by international standards or mercury sphygmomanometers validated were chosen. Standard-size cuffs with an airbag of 22–26 cm in length and 12 cm in width were used, and large-size airbag cuffs were used for obese individuals or those with large arm circumference (> 32 cm), with the airbag wrapped around at least 80% of the upper arm [7]. Each participant was asked to rest for at least 5 min, to be prohibited from smoking, to not drink coffee and tea for 30 min, and to empty the bladder. Participants should sit on the chairs with their bare upper arms at the same level as the heart and choose the right upper arm for the measurement [8]. Blood pressure was measured three times consecutively and repeated at 1–2 min each time. The average of the second and third readings was recorded, and the first blood pressure value was discarded. The blood pressure was measured by themselves and supervised by the head nurse to ensure consistency. Blood pressure values were also reported online.

2.3. Definitions

2.3.1. Diagnostic Criteria for Hypertension

The diagnostic criteria for hypertension were referred to the Chinese Guidelines for the Prevention and Control of Hypertension (2018 Revision) [9]: systolic blood pressure (SBP) ≥ 140 mm·Hg (1 mmHg = 0.133 kPa) or diastolic blood pressure (DBP) ≥ 90 mmHg without the use of antihypertensive drugs. Previous history of hypertension: A history of hypertension, currently on antihypertensive medication, and a blood pressure < 140/90 mmHg should still be diagnosed as hypertension.

2.3.2. Prevalence of Hypertension

The prevalence of hypertension is defined as the proportion of previous and new cases among survey respondents at a given time [10].

2.3.3. Relevant Definitions

  • 1. BMI: < 18.5 kg/m2 is considered underweight, 18.5∼< 24.0 kg/m2 is considered normal, 24.0∼< 28.0 kg/m2 considered overweight, and ≥ 28.0 kg/m2 is considered obese [11].

  • 2. Monthly night shift frequency: A shift starts after 19:00 and ends before 09:00 the following morning [12]. The questions obtained the night shift frequency: “What were the average number of night shifts per month you had in the past half a year?” The results were divided into four groups for analysis: no night shifts, five or fewer night shifts per month, more than five but fewer than or equal to 10 night shifts per month, and more than 10 night shifts per month.

  • 3. Hyperlipidemia, diabetes mellitus: “No” means no hyperlipidemia, diabetes mellitus.

  • 4. Family history of hypertension: at least one parent has hypertension.

  • 5. Smoking: “No” means no smoking in the past year.

  • 6. Alcohol consumption: “No” means no consumption of any alcohol in the past year [13].

  • 7. Exercise: running, walking, and other conscious activities lasting more than 30 min outside of working hours; “No” means no exercise and fitness activities in the past year [14].

2.4. Quality Control

Hebei Provincial Nursing Quality Control Center (NQCC) and the nursing department of each hospital were established as a hierarchical management mechanism to supervise the survey process. The survey team issued questionnaire notices to inform the methods of blood pressure measurements and precautions for questionnaire filling. In order to facilitate data collection and verification, this survey was conducted in batches according to geographical regions. The data were automatically uploaded to the network and returned to the NQCC after the respondents submitted. In case of missing and abnormal values, timely return visits and modifications were made to ensure the completeness and accuracy of the questionnaires. After data collection, all data were rechecked for completeness and logic to ensure accuracy.

2.5. Statistical Methods

All variables were statistically described. Random forest imputation was used to fill in missing value variables by R4.4.1. SPSS 27.0 software was used to analyze the data. The normality of the continuous variables was assessed. Variables following the skewed distribution were expressed by M (IQR), and comparisons were made using the rank-sum test. Categorical data were presented as frequencies and percentages, and a comparison was made using the χ2 test. Binary logistic regression was used to analyze the factors influencing hypertension. Multivariate linear regression analyzed SBP and DBP influencing factors. Multivariate analysis of variance was used to analyze the effect of the interaction between the monthly night shifts frequency and other blood pressure influencing factors. Differences were considered statistically significant at p < 0.05.

3. Results

3.1. Comparison of Hypertension Prevalence Among Emergency Department Nurses

The survey finally included 7218 emergency department nurses in Hebei Province, of which 6038 (83.65%) were female. The age range was 18∼64 years old, with a median age of 29 (8) years and a median BMI of 22.7 (5) kg/m2. The prevalence of hypertension among nurses in the emergency department of Hebei Province was 9.43% (681/7218), and the prevalence of hypertension was significantly higher in men (22.88%) than in women (6.81%). The blood pressure of nurses of different genders tended to increase with age and BMI. The prevalence of hypertension was higher in those with hyperlipidemia (39.21%), those with diabetes mellitus (46.84%), and those with smoking (21.14%) and alcohol consumption (10.46%), and the differences were statistically significant (p < 0.05), and a comparison of the prevalence of hypertension among emergency department nurses with different characteristics is shown in Table 1.

Table 1.

Comparison of hypertension prevalence among emergency department nurses with different characteristics (n = 7218).

Characteristics Groups Total (n, %) Prevalence of hypertension χ 2 p
Gender Women 6038 (83.65) 411 (6.81) 298.497 < 0.001
Men 1180 (16.35) 270 (22.88)
Age (years) 18∼25 1434 (19.87) 57 (3.97) 309.654 < 0.001
> 25∼35 4325 (59.92) 333 (7.70)
> 35∼45 1028 (14.24) 167 (16.25)
> 45 431 (5.97) 124 (28.77)
BMI (kg/m2) < 18.5 479 (6.64) 19 (3.97) 276.715 < 0.001
18.5∼24.0 4165 (57.70) 227 (5.45)
24.0∼< 28.0 1938 (26.85) 303 (15.63)
≥ 28.0 636 (8.81) 132 (20.75)
Educational background Technical secondary school 401 (5.56) 70 (17.46) 32.175 < 0.001
Junior college 3510 (48.63) 320 (9.12)
Undergraduate and above 3307 (45.82) 291 (8.80)
Marital status Married 5219 (72.31) 563 (10.79) 56.564 < 0.001
Unmarried 1856 (25.71) 96 (5.17)
Divorced or widowed 143 (1.98) 22 (15.38)
Hospital location Shijiazhuang 1356 (18.79) 87 (6.42) 43.780 < 0.001
Baoding 828 (11.47) 77 (9.30)
Cangzhou 701 (9.71) 76 (10.84)
Chengde 258 (3.57) 17 (7.36)
Handan 992 (13.74) 105 (10.58)
Hengshui 319 (4.42) 48 (15.05)
Langfang 572 (7.92) 45 (7.87)
Qinhuangdao 428 (5.93) 32 (7.48)
Tangshan 894 (12.39) 107 (11.99)
Xingtai 460 (6.37) 52 (11.30)
Zhangjiakou 410 (5.68) 33 (8.05)
Hospital grade Class I 158 (2.19) 14 (8.86) 2.235 0.327
Class II 4023 (55.74) 398 (9.89)
Class III 3037 (42.08) 269 (8.86)
Monthly night shift frequency 0 1082 (14.99) 102 (9.43) 0.807 0.848
> 0∼5 918 (12.72) 80 (8.71)
> 5∼10 4776 (66.17) 459 (9.61)
> 10 442 (6.12) 40 (9.05)
Hyperlipidemia Yes 533 (7.38) 209 (39.21) 597.201 < 0.001
No 6685 (92.62) 472 (7.06)
Diabetes mellitus Yes 79 (1.09) 37 (46.84) 130.760 < 0.001
No 7139 (98.90) 644 (9.02)
Family history of hypertension Yes 3525 (48.84) 366 (10.38) 7.250 0.007
No 3693 (51.16) 315 (8.53)
Antihypertensive medication Yes 250 (3.46) 250 (100.00) 2485.880 < 0.001
No 6968 (96.54) 431 (6.19)
Smoking Yes 317 (4.39) 67 (21.14) 53.126 < 0.001
No 6901 (95.61) 614 (8.90)
Alcohol consumption Yes 3852 (53.37) 403 (10.46) 10.203 < 0.001
No 3366 (46.63) 278 (8.26)
Exercise Yes 5747 (79.62) 531 (9.24) 1.257 0.262
No 1471 (20.38) 150 (10.20)
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3.2. Emergency Department Nurses Hypertension Prevalence Influencing Factors

Binary logistic regression analysis was performed with hypertension as the dependent variable, variables that were significant in the univariate analysis and monthly night shift frequency as the independent variables. The results showed that men (compared with females, OR = 4.047, 95% CI: 3.152–5.198), age (compared with 18∼25 years old, > 25∼35 years old OR = 1.574, 95% CI: 1.076–2.302, > 35∼45 years old OR = 2.718, 95% CI: 1.713–4.311, > 45 years old OR = 3.506, 95% CI: 2.015–6.101), BMI (compared to 18.5∼24.0 kg/m2, 24.0∼< 28.0 kg/m2 OR = 1.736, 95% CI: 1.369–2.201; > 28.0 kg/m2 OR = 2.044, 95% CI: 1.495–2.795), and coexisting hyperlipidemia (OR = 2.910, 95% CI: 2.187–3.817 compared to those without) are risk factors for hypertension prevalence among emergency department nurses, with statistically significant differences (p < 0.05), as shown in Tables 2 and 3.

Table 2.

Assignment of variables for binary logistic regression analysis.

Variable Assignment method
Gender 0 = “women”; 1 = “men”
Age (years) 1 = “18∼25”; 2 = “> 25–35”; 3 = “> 35∼45”; 4 = “> 45”
BMI (kg/m2) 1 = “18.5∼< 24.0”; 2 = “< 18.5”; 3 = “24.0∼< 28.0”; 4=“> 28.0”
Educational background 1 = “technical secondary school”; 2 = “junior college”; 3 = “undergraduate and above”
Marital status 1 = “married”; 2 = “unmarried”; 3 = “divorced or widowed”
Hospital location 1 = “Shijiazhuang”; 2 = “Baoding”; 3 = “Cangzhou”; 4 = “Chengde”; 5 = “Handan”; 6 = “Hengshui”; 7 = “Langfang”; 8 = “Qinhuangdao”; 9 = “Tangshan”; 10 = “Xingtai”; 11 = “Zhangjiakou”
Hospital grade 1 = “Class I”; 2 = “Class II”; 3 = “Class III”
Monthly night shift frequency 0 = “0”; 1 = “> 0∼5”; 2 = “> 5∼10”; 3 = “> 10”
Hyperlipidemia 0 = “no”; 1 = “yes”
Diabetes mellitus 0 = “no”; 1 = “yes”
Family history of hypertension 0 = “no”; 1 = “yes”
Antihypertensive medication 0 = “no”; 1 = “yes”
Smoking 0 = “no”; 1 = “yes”
Alcohol consumption 0 = “no”; 1 = “yes”
Exercise 0 = “no”; 1 = “yes”
Hypertension 0 = “no”; 1 = “yes”
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Table 3.

Binary logistic regression analysis of factors associated with hypertension prevalence among emergency department nurses.

Variables β SE χ 2 OR 95% CI p
Constant term −4.514 0.525 73.861 0.011 — < 0.001
Gender (compared to women)            
 Men 1.398 0.128 120.036 4.047 3.152–5.198 < 0.001
Age (years, compared to 18∼25 years)            
 > 25∼35 0.454 0.194 5.475 1.574 1.076–2.302 0.019
 > 35∼45 1.000 0.235 18.032 2.718 1.713–4.311 < 0.001
 > 45 1.255 0.283 19.712 3.506 2.015–6.101 < 0.001
BMI (kg/m2, compared to 18.5∼< 24.0 kg/m2)            
 < 18.5 −0.028 0.281 0.010 0.972 0.561–1.686 0.921
 24.0∼< 28.0 0.552 0.121 20.739 1.736 1.369–2.201 < 0.001
 > 28.0 0.715 0.160 20.094 2.044 1.495–2.795 < 0.001
Hyperlipidemia (compared to no)            
 Yes 1.068 0.146 53.788 2.910 2.187–3.871 < 0.001
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3.3. Comparison of SBP and DBP Among Emergency Department Nurses

The median level of SBP of all emergency department nursing staff was 112.0 (13) mmHg, and the median level of DBP was 70.0 (14) mmHg. The levels of SBP and DBP of male nurses were higher than those of females, and SBP and DBP increased with age and BMI, and the difference was statistically significant (p < 0.001). The level of blood pressure was different among educational background, marital status, hospital location and grade, and antihypertensive medication. SBP and DBP levels were elevated when hyperlipidemia, diabetes mellitus, or smoking and alcohol consumption were present, as shown in Table 4.

Table 4.

Comparison of systolic and diastolic blood pressure among emergency department nurses with different characteristics (n = 7218).

Characteristics Groups Systolic blood pressure (M (IQR), mmHg) Z p Diastolic blood pressure (M (IQR), mmHg) Z p
Gender Women 110 (15) −33.204 < 0.001 70 (15) −27.365 < 0.001
Men 125 (10) 80 (10)
Age (years) 18∼25 110 (14) 163.912 < 0.001 70 (14) 147.683 < 0.001
> 25∼35 110 (14) 70 (15)
> 35∼45 117 (18) 72 (14)
> 45 120 (20) 80 (15)
BMI (kg/m2) < 18.5 110 (16) 854.265 < 0.001 70 (14) 640.434 < 0.001
18.5∼< 24.0 110 (17) 70 (16)
24.0∼< 28.0 120 (20) 78 (10)
≥ 28.0 120 (14) 80 (15)
Educational background Technical secondary school 120 (19) 14.806 < 0.001 76 (10) 26.708 < 0.001
Junior college 112 (12) 70 (14)
Undergraduate and above 112 (14) 70 (15)
Marital status Married 115 (12) 29.225 < 0.001 70 (14) 16.823 < 0.001
Unmarried 110 (14) 70 (15)
Divorced or widowed 115 (16) 75 (10)
Hospital location Shijiazhuang 110 (15) 55.368 < 0.001 70 (15) 57.001 < 0.001
Baoding 112 (13) 70 (15)
Cangzhou 115 (15) 70 (15)
Chengde 110 (13) 70 (12)
Handan 115 (15) 70 (15)
Hengshui 120 (15) 75 (10)
Langfang 110 (11) 70 (13)
Qinhuangdao 11 (14) 70 (12)
Tangshan 116 (10) 74 (10)
Xingtai 115 (14) 72 (12)
Zhangjiakou 110 (18) 70 (15)
Hospital grade Class I 110 (10) 37.094 < 0.001 70 (10) 2.210 0.331
Class II 110 (14) 70 (12)
Class III 116 (16) 70 (15)
Monthly night shift frequency 0 110 (15) 7.780 0.051 70 (14) 7.768 0.051
> 0∼5 115 (14) 70 (15)
> 5∼10 113 (13) 70 (15)
> 10 115 (10) 74 (10)
Hyperlipidemia Yes 130 (21) −20.172 < 0.001 80 (15) −19.161 < 0.001
No 110 (14) 70 (15)
Diabetes mellitus Yes 121 (20) −6.846 < 0.001 80 (18) −7.007 < 0.001
No 112 (13)     70 (14)
Family history of hypertension Yes 113 (13) −1.287 0.198 70 (14) −0.775 0.438
No 112 (13)     70 (14)
Antihypertensive medication Yes 140 (15) −25.059 < 0.001 90 (10) −24.503 < 0.001
No 110 (14) 70 (15)
Smoking Yes 120 (20) −10.632 < 0.001 80 (15) −9.487 < 0.001
No 111 (14) 70 (15)
Alcohol consumption Yes 115 (14) −3.700 < 0.001 70 (13) −3.943 < 0.001
No 110 (14) 70 (15)
Exercise Yes 113 (13) −0.122 0.903 70 (15) −1.240 0.215
No 112 (12) 70 (13)
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3.4. SBP and DBP Influencing Factors Among Emergency Department Nurses

Multiple linear regression analysis was performed with SBP and DBP as dependent variables, respectively, and variables that were significant in the univariate analysis and monthly night shift frequency as independent variables. The results showed that the risk factors for SBP were men (compared to women), age > 35 years (compared to 18∼25 years), BMI ≥ 24.0 kg/m2 (compared to 18.5∼24.0 kg/m2), hospital location in Tangshan (compared to Shijiazhuang), monthly night shift frequency > 5 times (compared to 0), and hyperlipidemia. The protective factor was BMI < 18.5 kg/m2. The risk factors for DBP were men, age > 45 years, BMI ≥ 24.0 kg/m2, marital status of divorced or widowed (compared to married), hospital location of Tangshan, and hyperlipidemia. The protective factor was BMI < 18.5 kg/m2. Antihypertensive medication was an influencing factor for the SBP and DBP of the emergency department nurses. The differences were all statistically significant (p < 0.05), as shown in Tables 5 and 6.

Table 5.

Results of multiple linear regression analysis of systolic blood pressure influencing factors among emergency department nurses.

Variables B SE β t p
Constant term 107.558 1.203   89.390 < 0.001
Gender (compared to women)          
 Men 10.587 0.392 0.289 27.026 < 0.001
Age (years, compared to 18∼25 years)          
 > 35∼45 1.396 0.554 0.036 2.519 0.012
 > 45 4.649 0.724 0.081 6.423 < 0.001
BMI (kg/m2, compared to 18.5∼< 24.0 kg/m2)          
 < 18.5 −2.380 0.532 −0.044 −4.470 < 0.001
 24.0∼< 28.0 4.620 0.312 0.151 14.809 < 0.001
 ≥ 28.0 7.167 0.481 0.150 14.884 < 0.001
Hospital location (compared to Shijiazhuang)          
 Tangshan 1.458 0.480 0.036 2.519 0.012
Monthly night shift frequency (compared to 0)          
 > 5∼10 0.995 0.384 0.035 2.591 0.010
 > 10 1.503 0.638 0.027 2.356 0.019
Hyperlipidemia (compared to no) 4.704 0.537 0.091 8.752 < 0.001
Antihypertensive medication (compared to no) 22.730 0.756 0.307 30.081 < 0.001
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Note:R 2 = 0.353, adjusted R2 = 0.350, F = 118.921, p < 0.001.

Table 6.

Results of multiple linear regression analysis of diastolic blood pressure–influencing factors among emergency department nurses.

Variables B SE β t p
Constant term 70.083 0.940   74.565 < 0.001
Gender (compared to women)          
 Men 6.573 0.287 0.242 22.908 < 0.001
Age (years, compared to 18–25 years)          
 > 45 2.475 0.565 0.058 4.380 < 0.001
BMI (kg/m2, compared to 18.5∼< 24.0 kg/m2)          
 < 18.5 −1.716 0.416 −0.043 −4.129 < 0.001
 24.0∼< 28.0 2.913 0.244 0.129 11.961 < 0.001
 ≥ 28.0 4.645 0.376 0.131 12.361 < 0.001
Marital status (compared to married)          
 Divorced or widowed 1.968 0.726 0.027 2.710 0.007
Hospital location (compared to Shijiazhuang)          
 Tangshan 1.311 0.375 0.043 3.493 < 0.001
Hyperlipidemia (compared to no) 3.471 0.420 0.090 8.269 < 0.001
Antihypertensive medication (compared to no) 16.181 0.590 0.295 27.414 < 0.001
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Note:R 2 = 0.283, adjusted R2 = 0.279, F = 85.830, p < 0.001.

3.5. Interaction Analysis of the Effect of Monthly Night Shift Frequency on SBP and DBP of Emergency Department Nurses

The independent influencing factors of SBP and DBP are listed in Tables 5 and 6. Further analysis explored whether there is any interaction between the effects of each influencing factor. Rotating night shifts, as a common work pattern among nurses in the emergency department, can have an impact on blood pressure, so the interaction analysis was to explore the differences in the effect of the monthly night shift frequency on the blood pressure of the nurses in the grouping of different influencing factors, as shown in Table 7.

Table 7.

Interaction analysis of monthly night shift frequency and other blood pressure–influencing factors on systolic and diastolic blood pressure of emergency department nurses.

Variables Systolic blood pressure (mmHg) Diastolic blood pressure (mmHg)
Average value Standard error F p Average value Standard error F p
Marital status Monthly night shift frequency     2.156 0.044     1.675 0.123
 Married 0 132.1 0.874 2.524 0.056 85.9 0.683 1.288 0.277
  > 0∼5 132.9 0.909     86.7 0.710    
  > 5∼10 133.3 0.815     86.2 0.637    
  > 10 133.9 1.021     86.2 0.798    
 Unmarried       1.039 0.374     1.194 0.310
  0 131.8 1.269     86.9 0.992    
  > 0∼5 132.9 1.078     87.0 0.842    
  > 5∼10 133.5 0.867     86.5 0.677    
  > 10 133.2 1.200     87.9 0.937    
 Divorced or widowed       3.516 0.014     2.027 0.108
  0 133.7 2.698     88.5 2.108    
  > 0∼5 126.4 2.930     83.3 2.289    
  > 5∼10 136.1a 1.364     89.0 1.065    
  > 10 135.6 3.553     86.9 2.776    
Hospital grade       3.259 0.003     1.055 0.388
 Class I       4.604 0.003     1.866 0.133
  0 126.7 2.156     84.3 1.686    
  > 0∼5 137.0b 2.939     87.4 2.298    
  > 5∼10 134.3c 1.337     88.4 1.046    
  > 10 135.1 3.941     87.2 3.082    
 Class II       1.809 0.143     1.177 0.317
  0 132.6 0.917     86.9 0.717    
  > 0∼5 133.9 0.952     87.6 0.744    
  > 5∼10 133.0 0.832     86.9 0.650    
  > 10 133.7 0.984     87.5 0.770    
 Class III       3.064 0.027     0.268 0.849
  0 133.4 0.978     86.1 0.765    
  > 0∼5 133.5 0.972     86.6 0.760    
  > 5∼10 134.8 0.840     86.5 0.657    
  > 10 135.2 1.401     86.4 1.095    
Hyperlipidemia       5.540 < 0.001     4.995 0.002
 Yes       7.446 < 0.001     1.176 0.317
  0 131.5 1.353     85.9 1.057    
  > 0∼5 135.1 1.613     88.6 1.260    
  > 5∼10 137.1d 0.981     89.7 0.767f    
  > 10 139.0e 2.014     88.1 1.573    
 No       1.029 0.379     4.949 0.002
  0 130.7 0.952     85.3 0.744    
  > 0∼5 131.4 0.960     85.7 0.750    
  > 5∼10 131.3 0.894     85.2 0.699   < 0.001
  > 10 131.7 1.032     85.8 0.806    
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aStatistically significant difference in systolic blood pressure of emergency department nurses in the divorced or widowed group with a frequency of > 5∼10 night shifts compared with > 0∼5 times.

bStatistically significant difference in systolic blood pressure of emergency department nurses in Class I hospital with a frequency of > 0∼5 night shifts compared with 0 times.

cStatistically significant difference in systolic blood pressure of emergency department nurses in Class I hospital with a frequency of > 5∼10 night shifts compared with 0 times.

dStatistically significant difference in systolic blood pressure of emergency department nurses in the hyperlipidemia group with a frequency of > 5∼10 night shifts compared with 0 times.

eStatistically significant difference in systolic blood pressure of emergency department nurses in the hyperlipidemia group with a frequency of > 10 night shifts compared with 0 times.

fStatistically significant difference in diastolic blood pressure of emergency department nurses in the hyperlipidemia group with a frequency of > 5∼10 night shifts compared with 0 times.

After adjusting for gender, age, BMI, educational background, hospital location, hospital grade, hyperlipidemia, diabetes mellitus, family history of hypertension, antihypertensive medication, smoking, alcohol consumption, and exercise, the multivariate analysis of variance was conducted with SBP and DBP as dependent variables and marital status, monthly night shift frequency, and their interaction term as independent variables. The results showed an interaction effect between marital status and monthly night shift frequency on SBP. Among emergency department nurses who were divorced or widowed, those with an average monthly night shift frequency of > 5∼10 times in the past 6 months had a SBP increase of 9.7 mmHg compared to those with > 0∼5 times. Similarly, there was an interaction effect between hospital grade and monthly night shift frequency on SBP among emergency department nurses. Among emergency department nurses in Class I hospitals, those with the monthly night shift frequency of > 0∼5 times and > 5∼10 times over the past six months had SBP elevated by 10.3 and 7.6 mmHg, respectively, compared to those with 0 times. Hyperlipidemia and monthly night shift frequency had an interactive effect on SBP and DBP in emergency department nurses. Among emergency department nurses with hyperlipidemia, those with the monthly night shift frequency of > 5∼10 times and > 10 times over the past 6 months had SBP increases of 5.6 and 7.5 mmHg, respectively, compared to those with 0 times. Those with > 5∼10 times had a DBP increase of 3.8 mmHg compared to those with 0 times. All these differences were statistically significant (p < 0.05).

4. Discussion

4.1. The Hypertension Prevalence of Emergency Department Nurses Is Higher Than the Overall Prevalence of Nurses in Hebei Province

We found that the hypertension prevalence of emergency department nurses was 9.4%, which was significantly higher than the overall prevalence of nurses in Hebei Province (6.9%) [15]. It may relate to the characteristics of the emergency department, highly gathered acute and critical patients, an instantly changeable working environment, and the heavy task of resuscitation and management. Emergency department nurses need to be able to respond rapidly, judge comprehensively, and dispose of accurately. Further, physical exhaustion and mental stress can cause elevated blood pressure [16]. High blood pressure is associated with various complications, affecting emergency department nurses' health status and work quality. Thus, the blood pressure of the emergency department nurses should attract widespread attention.

4.2. Blood Pressure Influencing Factors of Emergency Department Nurses in Hebei Province

The present study showed that men were risk factors for blood pressure in emergency department nurses, with a significantly higher prevalence of hypertension (22.88%) than women (6.81%) and higher levels of SBP and DBP in men than in women, which is in line with previous findings [17]. The relevant mechanisms may be that high androgen levels in men promote a chronic inflammatory state, resulting in vascular endothelial dysfunction [18, 19]; high levels of estrogen in women exert antihypertensive effects by promoting nitric oxide production and downregulating the levels of angiotensin II type 1 receptor and endothelial 1 receptor [20]. Other possible reasons include differences in chromosomal gene expression as well as complex social and economic factors determined by differences in the life experiences of men and women [21, 22]. Given that men are a risk factor for hypertension and that this study suggests a higher prevalence of hypertension among male emergency department nurses, nursing managers should pay attention to the blood pressure health status of male nurses, strengthen blood pressure monitoring and management for this vulnerable population, and advocate for lifestyle improvements.

The present study showed that age is a risk factor for the prevalence of hypertension in emergency department nurses, with a 10 mmHg increase in SBP in nurses aged > 45 years compared to 18∼25 years, similar to the findings of Gallagher et al. [16]. The mechanism may involve a decrease in arterial elasticity and an increase in arterial stiffness with age, leading to reduced sensitivity of pressure receptors and diminished responsiveness of the β-adrenergic system. This results in increased peripheral vascular resistance, thereby causing elevated blood pressure [23]. Older emergency department nurses are experienced and often occupy critical positions requiring high levels of decision-making and judgment, such as triage and patient assessment. Correct decisions can shorten patients' waiting times and ensure they receive timely and effective treatment. Therefore, for older emergency department nurses, shifts should be scheduled reasonably. Employee health examinations should be prioritized, and a healthy lifestyle should be promoted to slow the rate at which hypertension increases with age.

Compared with normal BMI, the risk of hypertension prevalence increased 1.736 times in overweight emergency department nurses and 2.044 times in obese ones, and both SBP and DBP increased with increasing BMI; the BMI of underweight emergency department nurses was negatively correlated with SBP and DBP, which is in line with the findings of Hirose et al. that the BMI of either males or females was correlated with the prevalence of hypertension [24]. The potential mechanisms by which overweight or obesity may lead to hypertension include: overweight or obesity causing insulin resistance, reduced release of nitric oxide by vascular endothelium, and activation of the renin–angiotensin–aldosterone system (RAAS), resulting in elevated blood pressure [25]; inflammation and oxidative stress in visceral adipose tissue surrounding blood vessels leading to microvascular dysfunction and microvascular endothelial damage, exacerbating insulin resistance and subsequently leading to elevated blood pressure [26, 27]. Emergency department nurses have busy work schedules with frequent night shifts. Research reports indicate that night shift workers may increase the frequency of nighttime meals to alleviate work-related stress, which could further contribute to weight gain and an increased risk of hypertension [28].

Hyperlipidemia is a common comorbidity of hypertension, characterized by abnormally elevated lipid levels. The positive feedback loop between the two further increases the risk of cardiovascular disease. The results of this study indicate that emergency department nurses with hyperlipidemia have an increased risk of hypertension compared to those without hyperlipidemia, consistent with the findings of Gu and Zhou [29]. Abnormally elevated lipid levels can cause endothelial cell dysfunction, impaired nitric oxide production, and impaired vascular dilation function; they can also lead to enhanced sympathetic nerve function, increased angiotensin II secretion, and elevated blood pressure [30]. Therefore, lipid control is crucial for nurses, and relevant managers should regularly conduct health education, focus on improving health literacy, and ensure that individuals with abnormal lipid levels maintain a balanced diet, engage in regular exercise, and take lipid-lowering medications when necessary.

The results of this study indicate that an increase in monthly night shift frequency leads to elevated SBP among emergency department nurses. Compared to nurses with 0 night shifts per month, those with night shift frequencies of > 0∼5 times per month and > 5∼10 times per month had increased SBP. Additionally, there was an interaction effect between monthly night shift frequency and marital status, hospital grade, and hyperlipidemia. Among emergency department nurses who were divorced, widowed, worked in Class I hospitals, or with hyperlipidemia, the increase in blood pressure associated with a higher frequency of night shifts was more pronounced. Previous studies have also shown that divorce or widowhood is associated with elevated blood pressure [31]. Divorced and widowed individuals have relatively lower levels of intimate relationships and are more susceptible to negative emotions [32–34]. The study further found that divorced or widowed individuals with a monthly night shift frequency of > 5 times had relatively higher blood pressure levels. Managers can promote blood pressure stability by implementing flexible shift schedules, strengthening social support and psychological counseling for nurses, or arranging low-intensity day shifts after high-intensity, high-frequency night shifts. The study found that the higher the night shift frequency in Class I hospitals, the higher the SBP among emergency department nurses. This suggests that managers at all levels should pay attention to the impact of night shift frequency on nurses' blood pressure, ensure reasonable scheduling, and improve the satisfaction of nurses' rest areas to ensure adequate rest. Additionally, when implementing measures such as hypertension screening and follow-up, collaboration with medical staff from cardiology and endocrinology departments can enhance intervention effectiveness. Departments that arrange scientifically reasonable night shifts and achieve target hypertension control rates for nurses can be certified and rewarded. The study found that emergency department nurses with hyperlipidemia experienced a greater increase in blood pressure with increasing night shift frequency compared to those without hyperlipidemia. This may be related to the disruption of the circadian rhythm in emergency department nurses due to inverted day–night rhythms and frequent exposure to light at night, which directly affects the physiological circadian rhythm of the hypothalamus, leading to disorders in insulin secretion and carbohydrate and lipid metabolism rhythms [35–37]. Some studies have found that increased consumption of solid tea and caffeine or irregular eating patterns during night shifts may also lead to elevated blood lipids [38, 39]. Therefore, emergency department nurses should maintain normal blood pressure through adequate sleep, balanced diet, and other healthy lifestyle practices. Additionally, managers may provide low-fat, high-protein snacks during night shifts to reduce intake of high-fat, high-sugar foods.

The study findings revealed that the location of the hospital in Tangshan is a risk factor for SBP and DBP among emergency department nurses, which may be attributed to differences in socioeconomic conditions and dietary habits across geographical regions [40]. Tangshan is a coastal city, and the proportion of seafood in the diet may be relatively high. Higher cholesterol and fat intake can increase blood pressure. Additionally, the use of antihypertensive medications is a factor influencing SBP and DBP, indicating that some emergency department nurses taking antihypertensive medication have poor blood pressure control. Educational initiatives should be implemented to encourage nurses to actively learn about chronic diseases, recognize the importance of blood pressure control, and engage in high-quality blood pressure management.

This study has certain limitations: The census method was used, and blood pressure measurements were taken using a single-day repeated measurement method, making it difficult to conduct three measurements on different days. However, after consulting experts, this blood pressure measurement method was found to be reliable and more representative. Blood pressure measurements were taken using a desktop blood pressure monitor or a mercury blood pressure monitor. Survey participants self-reported their height and weight, and no standardized measurements were conducted. However, this study employed a census method to conduct a comprehensive survey of nurses across multiple centers, strictly adhering to a tiered management mechanism, providing standardized training, and utilizing scientifically rigorous measurement methods. These measures maximized the accuracy and stability of the data. Therefore, the study results are relatively reliable, possess good representativeness, and have strong generalizability.

5. Conclusion

In summary, the prevalence of hypertension among emergency department nurses is higher than the overall prevalence among nurses. Gender, age, BMI, and hyperlipidemia are factors influencing the prevalence of hypertension among emergency department nurses; gender, age, BMI, hospital location, monthly night shift frequency, hyperlipidemia, and antihypertensive medication use are factors influencing SBP among emergency department nurses; gender, age, BMI, marital status, hospital location, hyperlipidemia, and antihypertensive medication are factors influencing DBP. Emergency department nurses who are divorced or widowed, work in Class I hospitals, and have hyperlipidemia experience a more significant increase in blood pressure with increased monthly night shift frequency. Managers should pay attention to the blood pressure status of the aforementioned high-risk groups for hypertension and implement effective management and support measures. Additionally, emergency department nurses who are at high risk for hypertension should actively take preventive and control measures to maintain their blood pressure within normal levels.

Acknowledgments

We sincerely thank the directors of Nursing Quality Control Center in all cities of Hebei Province for their strong support in this study and thank all the nurses who participated in this study.

Nomenclature

SBP

Systolic blood pressure

DBP

Diastolic blood pressure

OR

Odds ratio

NQCC

Nursing Quality Control Center

IQR

Interquartile range

Data Availability Statement

The data that support the findings of this study are available upon request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

Ethics Statement

This study was approved by the Ethics Committee of The Second Hospital of Hebei Medical University (Approval number: 2016225).

Conflicts of Interest

The authors declare no conflicts of interest.

Author Contributions

Conceptualization: Bin Zhao, Jie Liu, Wenjia Liu; funding acquisition: Bin Zhao; data curation: Bin Zhao, Jie Liu, Jing Li; formal analysis: Wenjia Liu, Ni Chen, Suzhi Zhang; validation: Wenjia Liu, Suzhi Zhang; writing–original draft: Wenjia Liu, Jie Liu; writing–review and editing: Bin Zhao, Jie Liu, Ni Chen, Yufang Zhu, Yaping Wang, Xiaolin Zhang, XiaoRan Hao, Luqi Zhang, Yun Li; supervision: Bin Zhao, Jie Liu.

Funding

This study was supported by Hebei Provincial Department of Science and Technology (162777166).

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The data that support the findings of this study are available upon request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

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