General

Clinical Question:
Does work stress increase blood pressure?

Bottom Line:
Work stress has no meaningful effect on blood pressure. (LOE = 1b)

Reference:
Guimont C, Brisson C, Dagenais GR, et al. Effects of job strain on blood pressure: a prospective study of male and female white-collar workers. Am J Public Health 2006;96:1436-1443.  [PMID:16809603]

Study Design:
Cohort (prospective)

Funding:
Foundation

Setting:
Population-based

Synopsis:
"I don't need medication; my blood pressure is only high because of my stressful job." How should you respond? This team of researchers observed more than 6000 white-collar workers (men and women) for 7.5 years (84% follow-up). They excluded anyone with known cardiovascular disease and hypertension at baseline. The participants completed a series of scales to assess job stress and other psychological demands of work. Additionally, the study team assessed each participant's vital signs, body mass index, tobacco use, exercise patterns, and so forth. Women had no difference in their blood pressure whether exposed to stress at baseline or at follow-up, or at both, or neither. Men who experienced no work stress at baseline or at follow-up also showed no change in blood pressure. The excited authors, however, point out a graded response: Stress levels present only at baseline were less important than stress levels only at follow-up, and when men's stress levels were present at both baseline and at follow-up, the systolic blood pressure increased a whopping 1.8 mm Hg. This is a perfect example of how researchers can confuse and mislead us with statistics. Yes, the difference was statistically significant, but the clinical difference was trivial.