Kjeldsen Sverre E, Knudsen Karl, Ekrem Gunhild, Fure Tormod O, Movinckel Petter, Erikssen Jan E
Health Office, Fiskå Verk, Vågsbygd.
Blood Press. 2006;15(2):93-100. doi: 10.1080/08037050600750157.
Job strain may be associated with various diseases and increased mortality but there is little data available from prospective studies with long-term follow-up.
To assess the effect of heat exposure followed by severe job strain on blood pressure, heart rate and mortality.
Prospective 19-year observational study (1982-2000) of a cohort of employees in a ferry alloy plant undergoing two economical crises. The participants were 218 healthy males aged 30-59 years.
Annual standardized measurements of blood pressure, heart rate, serum cholesterol and registration of morbidity and mortality.
Heat-exposed men (n = 25) and non-heat-exposed men (n = 193) had unchanged blood pressure from 1982 to 1984. Thereafter the plant underwent two serious economic crises, in 1985-87 and 1990-91, respectively. The first one was handled by decisions exclusively taken by the head office and included a gradual lay-off of 25% of the workers, and the second one was handled jointly between the local management, union leaders and employees and included a modest, voluntary lay-off. Thus, the two crises differed markedly in low vs high job control. Blood pressures gradually increased from 1985 to 1988 in the whole cohort until systolic blood pressure reached 15 mmHg and diastolic blood pressure 12 mmHg above baseline levels (p < 0.001). Thereafter blood pressures decreased to slightly above baseline levels and then remained unchanged for the next 5 years. However, heart rate increased from 62 +/- 12 beats/min in 1982-83 to 69 +/- 10 beats/min in 1988 (p < 0.01) and did not return to baseline. Total mortality by 31 December 2000 in the study cohort was significantly higher over the 19 years of follow-up than among age-matched, Norwegian men (p < 0.01).
If a cause-effect relationship exists between the first economical crisis in the ferry alloy plant and the concomitant rise in blood pressure, job strain had a powerful but time-limited effect on blood pressure. Since the same phenomenon was not reproduced 5 years later, the marked difference in job control (high vs low) may constitute the difference. Alternatively, age-related effects or adaptive coping mechanisms may have prevented a similar second blood pressure rise despite exposure to a job strain of similar severity. However, there was also a high 19-year total mortality in the study population, which could be related to long-term health consequences of the first or both economic crises. This study provides some support for the notion that increased job strain elevates blood pressure and deteriorates outcome.
工作压力可能与多种疾病及死亡率增加有关，但长期随访的前瞻性研究数据较少。
评估高温暴露后紧接着严重工作压力对血压、心率和死亡率的影响。
对一家渡轮合金厂的员工队列进行为期19年（1982 - 2000年）的前瞻性观察研究，该工厂经历了两次经济危机。参与者为218名年龄在30 - 59岁的健康男性。
每年对血压、心率、血清胆固醇进行标准化测量，并记录发病率和死亡率。
1982年至1984年，暴露于高温的男性（n = 25）和未暴露于高温的男性（n = 193）血压无变化。此后，工厂分别在1985 - 1987年和1990 - 1991年经历了两次严重经济危机。第一次危机由总部独自做出决策应对，包括逐步裁员25%的工人，第二次危机由当地管理层、工会领袖和员工共同应对，包括适度的自愿裁员。因此，两次危机在工作控制程度高低方面存在显著差异。整个队列的血压从1985年至1988年逐渐升高，直至收缩压比基线水平升高15 mmHg，舒张压升高12 mmHg（p < 0.001）。此后血压降至略高于基线水平，然后在接下来的5年保持不变。然而，心率从1982 - 1983年的62 ± 12次/分钟增加到1988年的69 ± 10次/分钟（p < 0.01），且未恢复到基线水平。到2000年12月31日，研究队列在19年随访期间的总死亡率显著高于年龄匹配的挪威男性（p < 0.01）。
如果渡轮合金厂的第一次经济危机与同时出现的血压升高之间存在因果关系，那么工作压力对血压有强大但限时的影响。由于5年后未再现相同现象，工作控制程度的显著差异（高与低）可能是造成这种差异的原因。或者，与年龄相关的影响或适应性应对机制可能在尽管暴露于类似严重程度的工作压力下仍防止了类似的第二次血压升高。然而，研究人群的19年总死亡率也很高，这可能与第一次或两次经济危机的长期健康后果有关。这项研究为工作压力增加会升高血压并恶化预后这一观点提供了一些支持。
