Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Masked hypertension and effort-reward imbalance at work among 2369 white-collar workers

Journal of Human Hypertension volume 31, pages 620–626 (2017)Cite this article

Subjects

Abstract

Hypertension is an important risk factor of cardiovascular diseases, the leading cause of death worldwide. Adverse effects of psychosocial factors at work might increase the risk of masked hypertension, but evidences are still scarce. The objective of this study is then to determine whether adverse psychosocial work factors from the effort-reward imbalance (ERI) model are associated with the prevalence of masked hypertension in a population of white-collar workers. White-collar workers were recruited from three public organizations. Blood pressure was measured at the workplace for manually operated measurements (mean of the first three readings taken by a trained assistant) followed by ambulatory measurements (mean of all subsequent readings taken during the working day). Masked hypertension was defined as manually operated BP<140/90 mm Hg and ambulatory BP ⩾135/85 mm Hg. ERI exposure at work was measured using Siegrist’s validated questionnaire. Blood pressure readings were obtained from 2369 workers (participation proportion: 85%). ERI exposure (OR: 1.53 (95% CI: 1.16–2.02) and high efforts at work (OR: 1.61 (95% CI: 1.13–1.29) were associated with masked hypertension, after adjusting for sociodemographic and cardiovascular risk factors. Workers exposed to an imbalance between efforts spent at work and reward had a higher prevalence of masked hypertension. High efforts at work might be of particular importance in explaining this association. Future studies should be designed to investigate how clinicians can include questions on psychosocial work factors to screen for masked hypertension and how workplace interventions can decrease adverse psychosocial exposures to lower BP.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. WHO. Cardiovascular diseases. fact sheet.: media center; 2015. Available at. http://www.who.int/mediacentre/factsheets/fs317/en/index.html. (accessed on 30 September 2015).

  2. Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J . Global burden of hypertension: analysis of worldwide data. Lancet 2005; 365 (9455): 217–223.

    Article  PubMed  Google Scholar 

  3. Lawes CMM, Hoorn SV, Rodgers A . Global burden of blood-pressure-related disease, 2001. Lancet 2008; 371 (9623): 1513–1518.

    Article  PubMed  Google Scholar 

  4. Pickering TG, Eguchi K, Kario K . Masked hypertension: a review. Hypertens Res 2007; 30 (6): 479–488.

    Article  PubMed  Google Scholar 

  5. Peacock J, Diaz KM, Viera AJ, Schwartz JE, Shimbo D . Unmasking masked hypertension: prevalence, clinical implications, diagnosis, correlates and future directions. J Hum Hypertens 2014; 28 (9): 521–528.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Fagard RH, Cornelissen VA . Incidence of cardiovascular events in white-coat, masked and sustained hypertension versus true normotension: a meta-analysis. J Hypertens 2007; 25 (11): 2193–2198.

    Article  CAS  PubMed  Google Scholar 

  7. Mancia G, Bombelli M, Facchetti R, Madotto F, Quarti-Trevano F, Polo Friz H et al. Long-term risk of sustained hypertension in white-coat or masked hypertension. Hypertension 2009; 54 (2): 226–232.

    Article  CAS  PubMed  Google Scholar 

  8. Trudel X, Milot A, Brisson C . Persistence and progression of masked hypertension: a 5-year prospective study. Int J Hypertens 2013; 2013: 836387.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Pierdomenico SD, Pannarale G, Rabbia F, Lapenna D, Licitra R, Zito M et al. Prognostic relevance of masked hypertension in subjects with prehypertension. Am J Hypertens 2008; 21 (8): 879–883.

    Article  PubMed  Google Scholar 

  10. Gilbert-Ouimet M, Trudel X, Brisson C, Milot A, Vezina M . Adverse effects of psychosocial work factors on blood pressure: systematic review of studies on demand-control-support and effort-reward imbalance models. Scand J Work Environ Health 2013; 40: 109–132.

    Article  PubMed  Google Scholar 

  11. Karasek R . Job demands, job decision latitude, and mental strain: implications for job redesign. Adm Sci Quaterly 1979; 24: 285–308.

    Article  Google Scholar 

  12. Siegrist J . Adverse health effects of high-effort/low-reward conditions. J Occup Health Psychol 1996; 1 (1): 27–41.

    Article  CAS  PubMed  Google Scholar 

  13. Siegrist J, Starke D, Chandola T, Godin I, Marmot M, Niedhammer I et al. The measurement of effort-reward imbalance at work: European comparisons. Soc Sci Med 2004; 58: 1483–1499.

    Article  PubMed  Google Scholar 

  14. Brisson C, Aboa-Eboulé C, Leroux I, Gilbert-Ouimet M, Vézina M, Bourbonnais R et al. Psychosocial factors at work and heart disease, Heart and Mind: The Practice of Cardiac Psychology 2nd ed. American Psychological Association, Washington, 2011, 269–286.

    Book  Google Scholar 

  15. Landsbergis PA, Travis A, Schnall PL . Working conditions and masked hypertension. High Blood Press Cardiovasc Prev 2013; 20 (2): 69–76.

    Article  PubMed  Google Scholar 

  16. Trudel X, Brisson C, Milot A . Job strain and masked hypertension. Psychosom Med 2010; 72 (8): 786–793.

    Article  PubMed  Google Scholar 

  17. O'Brien E, Atkins N, Staessen J . State of the market. A review of ambulatory blood pressure monitoring devices. Hypertension 1995; 26 (5): 835–842.

    Article  CAS  PubMed  Google Scholar 

  18. Cloutier L, Daskalopoulou SS, Padwal R, Lamarre-Cliche M, Bolli P, McLean D et al. A new algorithm for the diagnosis of hypertension in Canada. Can J Cardiol 2015; 31 (5): 620–630.

    Article  PubMed  Google Scholar 

  19. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2013; 31 (7): 1281–1357.

    Article  CAS  Google Scholar 

  20. Niedhammer I, Siegrist J, Landre MF, Goldberg M, Leclerc A . [Psychometric properties of the French version of the Effort-Reward Imbalance model]. Rev Epidemiol Sante Publique 2000; 48 (5): 419–437.

    CAS  PubMed  Google Scholar 

  21. Daveluy C, Pica L, Audet N, Courtemanche R, Lapointe F . Enquête sociale et de santé 1998 2nd ed. Institut de la statistique du Québec: Québec, Canada, 2000.

    Google Scholar 

  22. Santé QuébecEnquête québécoise sur la santé cardiovasculaire 1990, Montréal, Ministère de la Santé et des Services sociaux, Gouvernement du Québec, Rapport final 1993.

  23. Lambert EA, Lambert GW . Stress and its role in sympathetic nervous system activation in hypertension and the metabolic syndrome. Curr Hypertens Rep 2011; 13 (3): 244–248.

    Article  PubMed  Google Scholar 

  24. Sata M, Fukuda D . Crucial role of renin-angiotensin system in the pathogenesis of atherosclerosis. J Med Invest 2010; 57 (1–2): 12–25.

    Article  PubMed  Google Scholar 

  25. Strike PC, Steptoe A . Psychosocial factors in the development of coronary artery disease. Prog Cardiovasc Dis 2004; 46 (4): 337–347.

    Article  PubMed  Google Scholar 

  26. Williams RB . Psychosocial and biobehavioral factors and their interplay in coronary heart disease. Annu Rev Clin Psychol 2008; 4: 349–365.

    Article  PubMed  Google Scholar 

  27. Chandola T, Britton A, Brunner E, Hemingway H, Malik M, Kumari M et al. Work stress and coronary heart disease: what are the mechanisms? Eur Heart J 2008; 29 (5): 640–648.

    Article  PubMed  Google Scholar 

  28. Peter R, Alfredsson L, Hammar N, Siegrist J, Theorell T, Westerholm P . High effort, low reward, and cardiovascular risk factors in employed Swedish men and women: baseline results from the WOLF Study. J Epidemiol Community Health. 1998; 52: 540–547.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Peter R, Siegrist J . Chronic psychosocial stress at work and crdiovascular disease: The role of effort-reward imbalance. Int J Law Psychiatry 1999; 22 (5–6): 441–449.

    Article  CAS  PubMed  Google Scholar 

  30. Bellingrath S, Weigl T, Kudielka BM . Chronic work stress and exhaustion is associated with higher allostastic load in female school teachers. Stress 2009; 12 (1): 37–48.

    Article  CAS  PubMed  Google Scholar 

  31. Forum WE . Gender Gap Report 2015. World Economic Forum: Geneva, Switzerland, 2015.

    Google Scholar 

  32. Siegrist J . Psychosocial work environment and health: new evidence. J Epidemiol Community Health. 2004; 58 (11): 888.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Konstantopoulou AS, Konstantopoulou PS, Papargyriou IK, Liatis ST, Stergiou GS, Papadogiannis DE . Masked, white coat and sustained hypertension: comparison of target organ damage and psychometric parameters. J Hum Hypertens 2010; 24 (3): 151–157.

    Article  CAS  PubMed  Google Scholar 

  34. Trevisol DJ, Moreira LB, Kerkhoff A, Fuchs SC, Fuchs FD . Health-related quality of life and hypertension: a systematic review and meta-analysis of observational studies. J Hypertens 2011; 29 (2): 179–188.

    Article  CAS  PubMed  Google Scholar 

  35. Song YK, Lee KK, Kim HR, Koo JW . Job demand and cardiovascular disease risk factor in white-collar workers. Industrial health 2010; 48 (1): 12–17.

    Article  PubMed  Google Scholar 

  36. Trudel X, Brisson C, Larocque B, Milot A . Masked hypertension: different blood pressure measurement methodology and risk factors in a working population. J Hypertens 2009; 27: 1560–1567.

    Article  CAS  PubMed  Google Scholar 

  37. Verberk WJ, Thien T, de Leeuw PW . Masked hypertension, a review of the literature. Blood Press Monit 2007; 12 (4): 267–273.

    Article  PubMed  Google Scholar 

  38. Hodgkinson J, Mant J, Martin U, Guo B, Hobbs FDR, Deeks JJ et al. Relative effectiveness of clinic and home blood pressure monitoring compared with ambulatory blood pressure monitoring in diagnosis of hypertension: systematic review. BMJ 2011; 342: d3621.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors would like to thank the subjects and organizations that participated in this study, which was funded by the Canadian Institutes of Health and Research (CIHR). This research was supported, in part, by a grant from the Canadian Institutes of Health Research (CIHR) and from the National Institute for Occupational Safety and Health (NIOSH). CB was a CIHR Investigator and XT and MGO were supported by a CIHR training award when this work was conducted.

Author information

Authors and Affiliations

  1. Population Health and Optimal Health Practices Unit,

    P Boucher, M Gilbert-Ouimet, X Trudel, C S Duchaine, A Milot & C Brisson

  2. CHU de Québec-Université Laval Research Center, Quebec, Quebec, Canada

    P Boucher, M Gilbert-Ouimet, X Trudel, C S Duchaine, A Milot & C Brisson

  3. Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec, Quebec, Canada

    P Boucher, M Gilbert-Ouimet, X Trudel & C Brisson

  4. Départment of Medicine, Faculty of Medicine, Laval University,, Quebec, Quebec, Canada

    A Milot

Authors
  1. P Boucher
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M Gilbert-Ouimet
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. X Trudel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C S Duchaine
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A Milot
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. C Brisson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P Boucher.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Additional information

Supplementary Information accompanies this paper on the Journal of Human Hypertension website

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Boucher, P., Gilbert-Ouimet, M., Trudel, X. et al. Masked hypertension and effort-reward imbalance at work among 2369 white-collar workers. J Hum Hypertens 31, 620–626 (2017). https://doi.org/10.1038/jhh.2017.42

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jhh.2017.42

This article is cited by

Search

Advanced search

Quick links