摘要：We reviewed evidence of the relationship between job strain and ambulatory blood pressure (ABP) in 29 studies (1985–2012). We conducted a quantitative meta-analysis on 22 cross-sectional studies of a single exposure to job strain. We systematically reviewed 1 case–control study, 3 studies of cumulative exposure to job strain, and 3 longitudinal studies. Single exposure to job strain in cross-sectional studies was associated with higher work systolic and diastolic ABP. Associations were stronger in men than women and in studies of broad-based populations than those with limited occupational variance. Biases toward the null were common, suggesting that our summary results underestimated the true association. Job strain is a risk factor for blood pressure elevation. Workplace surveillance programs are needed to assess the prevalence of job strain and high ABP and to facilitate workplace cardiovascular risk reduction interventions. HYPERTENSION IS PRIMARILY a disease of industrial societies, with a very low prevalence among hunter-gatherers, herders, and traditional agricultural communities. 1,2 In industrial societies, evidence has accumulated on the key role of working conditions in blood pressure (BP) elevation. For example, mean systolic ambulatory BP (ABP) is higher by approximately 4 millimeters of mercury (mm Hg) during work than outside of work, 3,4 and mean 24-hour ABP is lower on nonwork days than on workdays. 5,6 Associations with BP elevation have also been observed for work stressors such as long work hours, 7,8 effort–reward imbalance at work, 9 and threat-avoidant vigilant work, primarily professional driving. 10,11 The most widely studied work stressor is job strain (the combination of high psychological job demands and low job control). 12 Since 1985, numerous studies have reported a positive association between job strain and ABP or hypertension defined by level of ABP. These studies have used a range of populations and study designs of varying quality, making comparisons difficult. Several reviews of the association of job stressors and BP have been published, 13–16 but no one has conducted a quantitative meta-analysis, which allows for the estimation of an overall effect size. Although the conclusions of these reviews varied from support for 14–16 to skepticism toward 13 the hypothesis, all included measures of job stressors other than job strain, and 2 included measures of chronic stress outside the workplace. 14,15 Thus, none adequately evaluated the job strain–ABP association. Therefore, we conducted a quantitative meta-analysis and qualitative systematic review of studies of 1 primary work exposure, job strain, and ABP, as well as a systematic assessment of study validity. The previous reviews 13–16 included studies of casual clinic BP (CCBP), as well as ABP, as the outcome. Studies of work stressors and CCBP have not shown significant associations, except in a few larger studies. 17,18 CCBP measurements “often provide a poor estimate of risk in an individual patient for reasons such as observer error, the ‘white-coat’ effect … the inherent variability of blood pressure,” 19 (p2368) and unreliability. 20 On the other hand, ABP monitoring captures dynamic BP fluctuations in relation to daily life, including physical and psychosocial stimuli at work. ABP is also a much better predictor than CCBP of target organ damage 21,22 and incident cardiovascular disease. 23,24 We therefore focused on studies that used ABP as the outcome of interest.
