Job Stress and Blood Pressure: A Critical Appraisal of Reported Studies

Samuel   J.   Mann

Abstract

Stress clearly causes transient elevation of blood pressure, but its relationship to persisting elevation remains unclear. Job stress in particular is believed by many to contribute to persisting blood pressure elevation, but results of studies, which have never been comprehensively reviewed, have varied widely. The purpose of this review is to examine the results of such studies, and, based on those results, to challenge the prevailing belief that job stress is a significant contributor to the development of hypertension. Forty-eight studies have examined the relationship between job stress and casual blood pressure. 20 reported a positive association, although only 10 reported an association with systolic pressure for the entire cohort. Twenty-six studies have examined the relationship between job stress and ambulatory blood pressure. Seventeen of the 26 studies reported a positive association, although a positive association with systolic pressure in the entire cohort was seen in only 10 of the 26 studies. A qualitative review of positive findings revealed important concerns in the findings in many of the studies that reported an association, as detailed in the text and tables. In conclusion, results of studies of the relationship between job stress and blood pressure are highly inconsistent. In addition, major weaknesses in the findings of most studies that did report an association challenge the strength of the evidence they provide. Thus after decades of research, the evidence for a relationship between job stress and blood pressure is weak. Further, this review brings attention to the misleading but common practices of focusing on a single positive correlation or on a correlation limited to a single subgroup, while downplaying or frankly ignoring prominent negative findings, misleadingly perpetuating hypotheses that are likely to be untrue.

Keywords: emotional distress, hypertension, Ambulatory Blood Pressure, Casual Blood Pressure, Fauvel Study

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