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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.

"Job strain" (defined as high psychological demands and low decision latitude on the job) has been previously reported to be associated with increased risk of hypertension and increased left ventricular mass index (LVMI) in a case-control study of healthy employed men, aged 30-60 years, without evidence of coronary heart disease. We hypothesized that job strain would be associated with increased ambulatory blood pressure (AmBP). A total of 264 men at eight work sites wore an AmBP monitor for 24 hours on a working day. In an analysis of covariance model, job strain was associated with an increase in systolic AmBP of 6.8 mm Hg (p=0.002) and diastolic AmBP of 2.8 mm Hg at work (p=0.03) after adjusting for age, race, body mass index, Type A behavior, alcohol behavior, smoking, work site, 24-hour urine sodium, education, and physical demand level of the job. Alcohol use also had a significant effect on AmBP. However, among subjects not in high-strain jobs, alcohol had no apparent effect on AmBP at work. Instead, alcohol use and job strain interacted such that workers in high-strain jobs who drank regularly had significantly higher systolic AmBP at work (p=0.007). Among the other risk factors, only age, body mass index, and smoking had significant effects on AmBP. Job strain also had significant effects on AmBP at home and during sleep us well as on LVMI. A large body of previous research that suggests job strain is a risk factor for the development of coronary heart disease may now be partially explained as the consequence of elevation of blood pressure and structural changes in the heart (Hypertension 1 the results of a casecontrol study of employed men in which "job strain" (denned as high psychological demands and low decision latitude on the job) was found to be associated with an increased risk of hypertension after controlling for most other known risk factors. Although our research used traditional methods of casual blood pressure measurement conducted at the work site to define hypertension status, we were concerned about the known low reliability of this method due to error in measurement and high biological variability between measurements. As an alternative, we also measured blood pressure using ambulatory blood pressure (AmBP) monitors. AmBP monitors have solved several of the problems associated with casual blood pressure measurements. AmBP monitors can generate blood pressure estimates that are more reliable than casual blood pressure measurement due to the absence of observer error and the increased number of readings. In addition, AmBP monitor estimates of

The effectiveness of smoking cessation may be aided by modification of structural features of the work environment, such as job decision latitude. This study is limited by the small number of subjects who were engaged in high risk behaviors.

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Abstract-To evaluate the effects of shift work and race/ethnicity on the diurnal rhythm of blood pressure and urinary catecholamine excretion of healthy female nurses, 37 African American women and 62 women of other races underwent ambulatory blood pressure monitor and urine collection for 24 hours that included a full work shift: day shift (nϭ61), evening shift (nϭ11), and night shift (nϭ27). Awake and sleep times were evaluated from subjects' diaries. Of African Americans, 79% who were working evenings or nights and 32% working day shifts were nondippers (Ͻ10% drop in systolic pressure during sleep), whereas only 29% of others working eveningϩnight and 8% working day shifts were nondippers. Regression analyses indicated that eveningϩnight shift workers had a 5.4 mm Hg (PϽ0.001) smaller drop than day shift workers, and African Americans had a 4.0 mm Hg (PϽ0.01) smaller drop than others. The odds of an eveningϩnight shift worker being a nondipper were 6.1 times that of a day shift worker (PϽ0.001), and the odds of an African American were 7.1 times that of others (PϽ0.001). Total sleep time was significantly greater in the non-African American day shift workers than in the other 3 groups. After controlling for work shift and race/ethnicity, we determined that longer sleep times predicted less dipping (absolute and relative) in blood pressure. Urinary norepinephrine and epinephrine were higher during work than nonwork in both racial groups of day shift workers, but in eveningϩnight shift workers the difference was small and in the opposite direction. These results indicate that being African American and working evening or night shifts are independent predictors of nondipper status. Higher sleep blood pressure may contribute to the known adverse effects of shift work. (Hypertension. 1998;32:417-423.)

This 1985-1995 study was designed to assess the association between blood pressure (measured by using an ambulatory monitor) and history of exposure to job strain. Items from the Job Content Questionnaire were completed by 213 employed men, aged 30-60 years at entry into the Work Site Blood Pressure Study in New York City, New York, for each previous job they had held. The systolic blood pressure of men employed for >/=25 years who were exposed to job strain for 50% of their work life was 4.8 mmHg (95% confidence interval: -3.7, 13.4) higher at work and 7.9 mmHg (95% confidence interval: 0.8, 15.0) higher at home than that of men with no past exposure, independent of current exposure. Evidence was inconsistent for the hypothesis of rapid induction of/recovery from the effects of job strain on blood pressure, and there was little effect of past job strain on diastolic blood pressure. These findings provide some support for the hypothesis of an effect of cumulative burden of exposure to job strain on systolic blood pressure.

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