Kivimäki Mika, Head Jenny, Ferrie Jane E, Shipley Martin J, Steptoe Andrew, Vahtera Jussi, Marmot Michael G
Department of Epidemiology and Public Health, University College London Medical School, London, United Kingdom.
Am J Hypertens. 2007 Nov;20(11):1146-53. doi: 10.1016/j.amjhyper.2007.06.006.
Hypertension is assumed to be one of the mechanisms through which job strain (a combination of high work demands and low job control) increases coronary heart-disease risk. However, direct tests of this hypothesis are lacking.
We examined whether hypertension mediated the association between job strain and incident coronary heart disease among 5630 men and 2456 women free of coronary heart disease at study entry. Job strain was assessed at phase 1 (1985 to 1988); hypertension and systolic and diastolic blood pressure (BP) were assessed at phases 1, 3 (1992 to 1993), and 5 (1997 to 1999); and incident coronary heart disease was assessed from the end of phase 1 to phase 7 (2003 to 2004) (698 events; median follow-up, 16.1 years).
After adjustment for age, sex, ethnicity, and employment grade, job strain was associated with an increased incidence of coronary heart disease. Further adjustments, for hypertension, systolic BP, and diastolic BP at phase 1 and across phases 1, 3, and 5, and the slope of hypertension and BP over time, had little effect on this association, although measures of hypertension and BP were strongly related to incident coronary heart disease.
Data, including repeated casual measurements of hypertension and BP, suggest that the development of chronic hypertension is not a key mechanism linking job strain and coronary heart disease. Further research on ambulatory measurements is needed to determine whether episodic BP elevations have a role in this association.
高血压被认为是工作压力（高工作要求与低工作控制的结合）增加冠心病风险的机制之一。然而，这一假设缺乏直接验证。
我们研究了高血压是否介导了工作压力与冠心病发病之间的关联，研究对象为5630名男性和2456名女性，研究开始时均无冠心病。在第1阶段（1985年至1988年）评估工作压力；在第1、3阶段（1992年至1993年）和第5阶段（1997年至1999年）评估高血压以及收缩压和舒张压；从第1阶段结束至第7阶段（2003年至2004年）评估冠心病发病情况（698例事件；中位随访时间为16.1年）。
在调整年龄、性别、种族和就业等级后，工作压力与冠心病发病率增加相关。进一步调整第1阶段以及第1、3、5阶段的高血压、收缩压和舒张压，以及高血压和血压随时间的变化斜率，对这种关联影响不大，尽管高血压和血压测量值与冠心病发病密切相关。
包括多次偶然测量高血压和血压的数据表明，慢性高血压的发展不是工作压力与冠心病之间联系的关键机制。需要进一步研究动态测量，以确定血压的间歇性升高在这种关联中是否起作用。
