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Psychosocial Predictors for Hypertension Differ for Men and Women
By Donald J. Brown, ND

Healthnotes Newswire —Job-related stressors, including a low-status job and the threat of unemployment, are associated with an increased risk of developing high blood pressure—particularly in men—according to a study published in this week’s issue of Archives of Internal Medicine.1

The study also found that feelings of depression or alienation were more likely to increase the risk of hypertension (chronic high blood pressure) in women. In both sexes, low occupational status, low education, and African-American race were associated with a greater risk of hypertension.

Two surveys—one in 1974 and the other in 1994—of adult male and female residents of Alameda County, California comprised the study. The surveys consisted of questions designed to determine the effects of various psychosocial factors on the development of hypertension. In addition to potential psychological predictors of hypertension, such as depression, social discontent, or alienation, questions also focused on work-related stressors. These included unemployment, worry about job-retention, feeling average or inadequate about job performance, and having a low-status job (i.e. clerical, sales, or blue collar, as opposed to white collar, professional, or managerial).

Non-psychological risk factors of hypertension, such as smoking, obesity, alcohol use, and leisure time physical activity, were also included in the surveys. However, the researchers failed to include salt intake or family history of hypertension, two well-established risk factors for high blood pressure.

In men, work-related stressors were the most prominent risk associated with development of high blood pressure. These stressors included job insecurity, unemployment, and inadequate job performance.

Although women who developed high blood pressure were likely to report low job status, psychological distress was by far their most predictive risk factor. The study found that reports of depression and feelings of discontent and/or social alienation were more commonly associated with the development of hypertension in women.

While this is the first study to find clear differences between the sexes regarding psychosocial stressors and risk of hypertension, it is not the first to find that job strain or dissatisfaction and psychological distress may increase the risk of hypertension. Analyses from the National Health and Nutrition Examination Survey 1 also found anxiety and depression to predict development of high blood pressure.2 Job strain and the combination of high work demands with low decision-making latitude have been associated with high blood pressure in other population studies as well.3 4

The results of this new study are somewhat limited by the fact that only people who were treated for high blood pressure were considered. Also, the researchers did not directly measure blood pressure; a factor that likely means elevated blood pressure was under-reported in the study.

In addition to the established physical risk factors of hypertension, such as poor diet, smoking, obesity and lack of exercise, this study brings important focus on the role of the mind and emotions as additional risk factors. Programs aimed at reducing the risk of hypertension must take a comprehensive approach that gives equal attention to both of these areas.

References
1. Levenstein S, Smith MW, Kaplan GA. Psychosocial predictors of hypertension in men and women. Arch Intern Med 2001;161:1341–6
2. Jonas BB, Franks P, Ingram DD. Are symptoms of anxiety and depression risk factors for hypertension? Longitudinal evidence from the National Health and Nutrition Examination Survey 1 Epidemiological Follow-Up Study. Arch Fam Med 1997;6:43–9.
3. Pickering TG, Devereux RB, James GD, et al. Environmental influences on blood pressure and the role of job strain. J Hypertens 1996 (Suppl):14:S179–S185.
4. Landsbergis PA, Schnall PL, Warren K, et al. Association between ambulatory blood pressure and alternative formulations of job strain. Scand J Work Environ Health 1994;20:349–63.

Donald J. Brown, ND, is a naturopathic physician and one of the leading authorities in the United States on evidence-based herbal medicine. He is the founder and director of Natural Products Research Consultants, Inc., and serves on the Advisory Board of the American Botanical Council and the President's Advisory Board of Bastyr University.




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