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. 2001 Jun;58(6):367–373. doi: 10.1136/oem.58.6.367

Association between job strain and prevalence of hypertension: a cross sectional analysis in a Japanese working population with a wide range of occupations: the Jichi Medical School cohort study

A Tsutsumi 1, K Kayaba 1, K Tsutsumi 1, M Igarashi 1
PMCID: PMC1740148  PMID: 11351051

Abstract

OBJECTIVES—To explore the association between the prevalence of hypertension in a Japanese working population and job strain (a combination of low control over work and high psychological demands), and to estimate this association in different sociodemographic strata.
METHODS—From a multicentre community based cohort study of Japanese people, sex specific cross sectional analyses were performed on 3187 men and 3400 women under 65 years of age, all of whom were actively engaged in various occupations throughout Japan. The baseline period was 1992-4. The association between job characteristics—measured with a Japanese version of the Karasek demand-control questionnaire—and the prevalence of hypertension defined by blood pressure and from clinical diagnoses were examined. Adjustments were made for possible confounders. The analyses were repeated for stratified categories of occupational class, educational attainment, and age group.
RESULTS—In men, the level of job strain (the ratio of psychological job demands to job control) correlated with the prevalence of hypertension. In a multiple logistic regression model, job strain was significantly related to hypertension (odds ratio 1.18; 95% confidence interval 1.05 to 1.32), after adjustment for age, employment (white collar v blue collar), marital status, family history of hypertension, cigarette smoking, alcohol intake, physical activity, and body mass index. The stratified analyses showed significant excess risks in the subordinate groups compared with managers, blue collar workers, less educated workers, and the older age groups. This association was not significant in women. Multiple linear regression analyses, with systolic and diastolic blood pressures as dependent variables, did not show any significant association.
CONCLUSIONS—The findings provided limited proof that job strain is related to hypertension in Japanese working men. Older men in a lower social class may be more vulnerable to the hypertensive effects of job strain.


Keywords: hypertension; stress; psychological; work

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Selected References

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  1. Albright C. L., Winkleby M. A., Ragland D. R., Fisher J., Syme S. L. Job strain and prevalence of hypertension in a biracial population of urban bus drivers. Am J Public Health. 1992 Jul;82(7):984–989. doi: 10.2105/ajph.82.7.984. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Chapman A., Mandryk J. A., Frommer M. S., Edye B. V., Ferguson D. A. Chronic perceived work stress and blood pressure among Australian government employees. Scand J Work Environ Health. 1990 Aug;16(4):258–269. doi: 10.5271/sjweh.1786. [DOI] [PubMed] [Google Scholar]
  3. Greenlund K. J., Liu K., Knox S., McCreath H., Dyer A. R., Gardin J. Psychosocial work characteristics and cardiovascular disease risk factors in young adults: the CARDIA study. Coronary Artery Risk Disease in Young Adults. Soc Sci Med. 1995 Sep;41(5):717–723. doi: 10.1016/0277-9536(94)00385-7. [DOI] [PubMed] [Google Scholar]
  4. Hall E. M. Gender, work control, and stress: a theoretical discussion and an empirical test. Int J Health Serv. 1989;19(4):725–745. doi: 10.2190/5MYW-PGP9-4M72-TPXF. [DOI] [PubMed] [Google Scholar]
  5. Hinojosa-Laborde C., Chapa I., Lange D., Haywood J. R. Gender differences in sympathetic nervous system regulation. Clin Exp Pharmacol Physiol. 1999 Feb;26(2):122–126. doi: 10.1046/j.1440-1681.1999.02995.x. [DOI] [PubMed] [Google Scholar]
  6. Iwata N., Roberts C. R., Kawakami N. Japan-U.S. comparison of responses to depression scale items among adult workers. Psychiatry Res. 1995 Oct 16;58(3):237–245. doi: 10.1016/0165-1781(95)02734-e. [DOI] [PubMed] [Google Scholar]
  7. Johnson J. V., Hall E. M. Job strain, work place social support, and cardiovascular disease: a cross-sectional study of a random sample of the Swedish working population. Am J Public Health. 1988 Oct;78(10):1336–1342. doi: 10.2105/ajph.78.10.1336. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Johnson J. V., Stewart W. F. Measuring work organization exposure over the life course with a job-exposure matrix. Scand J Work Environ Health. 1993 Feb;19(1):21–28. doi: 10.5271/sjweh.1508. [DOI] [PubMed] [Google Scholar]
  9. Kannel W. B., Sorlie P. Some health benefits of physical activity. The Framingham Study. Arch Intern Med. 1979 Aug;139(8):857–861. [PubMed] [Google Scholar]
  10. Kario K., Nago N., Kayaba K., Saegusa T., Matsuo H., Goto T., Tsutsumi A., Ishikawa S., Kuroda T., Miyamoto T. Characteristics of the insulin resistance syndrome in a Japanese population. The Jichi Medical School Cohort Study. Arterioscler Thromb Vasc Biol. 1996 Feb;16(2):269–274. doi: 10.1161/01.atv.16.2.269. [DOI] [PubMed] [Google Scholar]
  11. Kasl S. V. The influence of the work environment on cardiovascular health: a historical, conceptual, and methodological perspective. J Occup Health Psychol. 1996 Jan;1(1):42–56. doi: 10.1037//1076-8998.1.1.42. [DOI] [PubMed] [Google Scholar]
  12. Kawakami N., Haratani T., Araki S. Job strain and arterial blood pressure, serum cholesterol, and smoking as risk factors for coronary heart disease in Japan. Int Arch Occup Environ Health. 1998 Sep;71(6):429–432. doi: 10.1007/s004200050302. [DOI] [PubMed] [Google Scholar]
  13. Kornitzer M., Dramaix M., De Backer G. Epidemiology of risk factors for hypertension: implications for prevention and therapy. Drugs. 1999 May;57(5):695–712. doi: 10.2165/00003495-199957050-00003. [DOI] [PubMed] [Google Scholar]
  14. Kristensen T. S. Job stress and cardiovascular disease: a theoretic critical review. J Occup Health Psychol. 1996 Jul;1(3):246–260. doi: 10.1037//1076-8998.1.3.246. [DOI] [PubMed] [Google Scholar]
  15. Light K. C., Turner J. R., Hinderliter A. L. Job strain and ambulatory work blood pressure in healthy young men and women. Hypertension. 1992 Aug;20(2):214–218. doi: 10.1161/01.hyp.20.2.214. [DOI] [PubMed] [Google Scholar]
  16. Lindquist T. L., Beilin L. J., Knuiman M. W. Influence of lifestyle, coping, and job stress on blood pressure in men and women. Hypertension. 1997 Jan;29(1 Pt 1):1–7. doi: 10.1161/01.hyp.29.1.1. [DOI] [PubMed] [Google Scholar]
  17. MacMahon S., Cutler J., Brittain E., Higgins M. Obesity and hypertension: epidemiological and clinical issues. Eur Heart J. 1987 May;8 (Suppl B):57–70. doi: 10.1093/eurheartj/8.suppl_b.57. [DOI] [PubMed] [Google Scholar]
  18. Marmot M. G., Bosma H., Hemingway H., Brunner E., Stansfeld S. Contribution of job control and other risk factors to social variations in coronary heart disease incidence. Lancet. 1997 Jul 26;350(9073):235–239. doi: 10.1016/s0140-6736(97)04244-x. [DOI] [PubMed] [Google Scholar]
  19. Marmot M. G., Rose G., Shipley M., Hamilton P. J. Employment grade and coronary heart disease in British civil servants. J Epidemiol Community Health. 1978 Dec;32(4):244–249. doi: 10.1136/jech.32.4.244. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Marmot M., Theorell T. Social class and cardiovascular disease: the contribution of work. Int J Health Serv. 1988;18(4):659–674. doi: 10.2190/KTC1-N5LK-J1PM-9GRQ. [DOI] [PubMed] [Google Scholar]
  21. Nago N., Kayaba K., Hiraoka J., Matsuo H., Goto T., Kario K., Tsutsumi A., Nakamura Y., Igarashi M. Lipoprotein(a) levels in the Japanese population: influence of age and sex, and relation to atherosclerotic risk factors. The Jichi Medical School Cohort Study. Am J Epidemiol. 1995 May 1;141(9):815–821. doi: 10.1093/oxfordjournals.aje.a117516. [DOI] [PubMed] [Google Scholar]
  22. Niedhammer I., Goldberg M., Leclerc A., David S., Bugel I., Landre M. F. Psychosocial work environment and cardiovascular risk factors in an occupational cohort in France. J Epidemiol Community Health. 1998 Feb;52(2):93–100. doi: 10.1136/jech.52.2.93. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Nyklícek I., Vingerhoets J. J., Van Heck G. L. Hypertension and objective and self-reported stressor exposure: a review. J Psychosom Res. 1996 Jun;40(6):585–601. doi: 10.1016/0022-3999(95)00647-8. [DOI] [PubMed] [Google Scholar]
  24. Rostrup M., Ekeberg O. Awareness of high blood pressure influences on psychological and sympathetic responses. J Psychosom Res. 1992 Feb;36(2):117–123. doi: 10.1016/0022-3999(92)90020-3. [DOI] [PubMed] [Google Scholar]
  25. Schnall P. L., Landsbergis P. A., Baker D. Job strain and cardiovascular disease. Annu Rev Public Health. 1994;15:381–411. doi: 10.1146/annurev.pu.15.050194.002121. [DOI] [PubMed] [Google Scholar]
  26. Schnall P. L., Pieper C., Schwartz J. E., Karasek R. A., Schlussel Y., Devereux R. B., Ganau A., Alderman M., Warren K., Pickering T. G. The relationship between 'job strain,' workplace diastolic blood pressure, and left ventricular mass index. Results of a case-control study. JAMA. 1990 Apr 11;263(14):1929–1935. [PubMed] [Google Scholar]
  27. Schnall P. L., Schwartz J. E., Landsbergis P. A., Warren K., Pickering T. G. A longitudinal study of job strain and ambulatory blood pressure: results from a three-year follow-up. Psychosom Med. 1998 Nov-Dec;60(6):697–706. doi: 10.1097/00006842-199811000-00007. [DOI] [PubMed] [Google Scholar]
  28. Schnall P. L., Schwartz J. E., Landsbergis P. A., Warren K., Pickering T. G. Relation between job strain, alcohol, and ambulatory blood pressure. Hypertension. 1992 May;19(5):488–494. doi: 10.1161/01.hyp.19.5.488. [DOI] [PubMed] [Google Scholar]
  29. Sugisawa A., Uehata T., Pin H., Sekiya E., Chida T., Ishihara S., Yamazaki Y., Sakano J., Abe M., Hasegawa Y. [Mental health, work environment, and health practices among middle-aged male workers]. Sangyo Igaku. 1993 Jan;35(1):7–18. doi: 10.1539/joh1959.35.7. [DOI] [PubMed] [Google Scholar]
  30. Syme S. L., Oakes T. W., Friedman G. D., Feldman R., Siegelaub A. B., Collen M. Social class and racial differences in blood pressure. Am J Public Health. 1974 Jun;64(6):619–620. doi: 10.2105/ajph.64.6.619. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Tarumi K., Hagihara A., Morimoto K. An inquiry into the relationship between job strain and blood pressure in male white-collar workers. Sangyo Igaku. 1993 Jul;35(4):269–276. doi: 10.1539/joh1959.35.269. [DOI] [PubMed] [Google Scholar]
  32. Theorell T., Ahlberg-Hulten G., Jodko M., Sigala F., de la Torre B. Influence of job strain and emotion on blood pressure in female hospital personnel during workhours. Scand J Work Environ Health. 1993 Oct;19(5):313–318. doi: 10.5271/sjweh.1469. [DOI] [PubMed] [Google Scholar]
  33. Theorell T., Karasek R. A. Current issues relating to psychosocial job strain and cardiovascular disease research. J Occup Health Psychol. 1996 Jan;1(1):9–26. doi: 10.1037//1076-8998.1.1.9. [DOI] [PubMed] [Google Scholar]
  34. Theorell T., Perski A., Akerstedt T., Sigala F., Ahlberg-Hultén G., Svensson J., Eneroth P. Changes in job strain in relation to changes in physiological state. A longitudinal study. Scand J Work Environ Health. 1988 Jun;14(3):189–196. doi: 10.5271/sjweh.1932. [DOI] [PubMed] [Google Scholar]
  35. Theorell T., Tsutsumi A., Hallquist J., Reuterwall C., Hogstedt C., Fredlund P., Emlund N., Johnson J. V. Decision latitude, job strain, and myocardial infarction: a study of working men in Stockholm. The SHEEP Study Group. Stockholm Heart epidemiology Program. Am J Public Health. 1998 Mar;88(3):382–388. doi: 10.2105/ajph.88.3.382. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Theorell T., de Faire U., Johnson J., Hall E., Perski A., Stewart W. Job strain and ambulatory blood pressure profiles. Scand J Work Environ Health. 1991 Dec;17(6):380–385. doi: 10.5271/sjweh.1690. [DOI] [PubMed] [Google Scholar]
  37. Ueshima H., Shimamoto T., Iida M., Konishi M., Tanigaki M., Doi M., Tsujioka K., Nagano E., Tsuda C., Ozawa H. Alcohol intake and hypertension among urban and rural Japanese populations. J Chronic Dis. 1984;37(7):585–592. doi: 10.1016/0021-9681(84)90008-0. [DOI] [PubMed] [Google Scholar]
  38. Van Egeren L. F. The relationship between job strain and blood pressure at work, at home, and during sleep. Psychosom Med. 1992 May-Jun;54(3):337–343. doi: 10.1097/00006842-199205000-00009. [DOI] [PubMed] [Google Scholar]
  39. Watt G. C., Harrap S. B., Foy C. J., Holton D. W., Edwards H. V., Davidson H. R., Connor J. M., Lever A. F., Fraser R. Abnormalities of glucocorticoid metabolism and the renin-angiotensin system: a four-corners approach to the identification of genetic determinants of blood pressure. J Hypertens. 1992 May;10(5):473–482. doi: 10.1097/00004872-199205000-00011. [DOI] [PubMed] [Google Scholar]

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