Trudel Xavier, Brisson Chantal, Milot Alain, Masse Benoit, Vézina Michel
Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Québec, Canada Département de médecine sociale et préventive, Université Laval, Québec, Canada.
Département de médecine, Université Laval, Québec, Canada.
J Epidemiol Community Health. 2016 Apr;70(4):402-8. doi: 10.1136/jech-2014-204914. Epub 2015 Nov 3.
Two main theoretical models have been used to assess the impact of psychosocial work factors on blood pressure (BP): the demand-control (DC) model and the effort-reward imbalance (ERI) model. Previous studies have mostly used a single time point exposure to examine this association.
To examine the effect of repeated job strain and ERI exposure on (1) ambulatory BP (ABP) evolution over 5 years and (2) hypertension incidence over 5 years.
The design is a prospective cohort study. The study population was composed of 1394 white-collar workers (568 men and 826 women). They were assessed three times during a 5-year period (years 1, 3 and 5). At each time, psychosocial work factors were measured using validated scales and ABP was measured every 15 min during a working day.
Men who were chronically exposed over 5 years to an active job had a higher cumulative incidence of hypertension (RR=2.05, 95% CI 1.36 to 3.09), compared with never-exposed men. In women, ERI exposure onset was associated with higher increases in systolic ABP (+2.5 mm Hg). No association was found between chronic high-strain exposure and ABP.
Chronic exposure to active jobs in men led to a higher risk of hypertension and ERI exposure onset in women led to increases in systolic ABP. Results from the present study highlight the need to consider chronic exposure in order to fully capture the deleterious effect of adverse psychosocial work stressors on cardiovascular health.
两种主要的理论模型已被用于评估心理社会工作因素对血压（BP）的影响：需求 - 控制（DC）模型和努力 - 回报失衡（ERI）模型。以往的研究大多使用单一时间点的暴露来检验这种关联。
研究重复的工作压力和ERI暴露对（1）5年期间动态血压（ABP）变化以及（2）5年期间高血压发病率的影响。
本研究为前瞻性队列研究。研究人群由1394名白领工人（568名男性和826名女性）组成。在5年期间（第1年、第3年和第5年）对他们进行了三次评估。每次评估时，使用经过验证的量表测量心理社会工作因素，并在工作日期间每15分钟测量一次ABP。
与从未暴露的男性相比，5年中长期暴露于工作压力的男性高血压累积发病率更高（RR = 2.05，95%CI为1.36至3.09）。在女性中，ERI暴露开始与收缩压ABP升高幅度更大（+2.5 mmHg）相关。未发现长期高压力暴露与ABP之间存在关联。
男性长期暴露于工作压力会导致更高的高血压风险，而女性ERI暴露开始会导致收缩压ABP升高。本研究结果强调了考虑长期暴露的必要性，以便充分捕捉不良心理社会工作压力源对心血管健康的有害影响。
