title: Working conditions and masked hypertension.
abstract: BACKGROUND
  Masked hypertension, i.e., normal clinic blood pressure but elevated blood pressure during normal daily activities as measured by ambulatory monitoring, is a common problem and a serious cardiovascular risk factor. Given previously reported associations between work stressors and ambulatory blood pressure, an inquiry into the relationship between work stressors and masked hypertension is warranted.
  
  
  OBJECTIVE
  To assess the relationship between working conditions and masked hypertension.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Hospital and home care employers in New York City.
  
  
  METHODS
  Forty-five male and 119 female hospital and home care employee volunteers wore an ambulatory blood pressure monitor during working hours.
  
  
  METHODS
  Masked hypertension was defined as work systolic ambulatory blood pressure ≥135 mmHg or diastolic ambulatory blood pressure ≥85 mmHg, and casual blood pressure <140/90 mmHg with no use of antihypertensive medications. Associations between work stressors and masked hypertension were tested by multiple logistic regression.
  
  
  RESULTS
  Masked hypertension, observed in 24.0% of males and 17.6% of females with normal casual office obtained blood pressure, was associated with evening, night or rotating shiftwork (odds ratio (OR) 8.25, 95% confidence interval (CI) 2.11-40.31) and with the combination of job strain and effort-reward imbalance (OR 2.97, 95% CI 1.02-8.60) after controlling for age. Associations remained substantial, and statistically significant for shiftwork, after individual adjustment for each of 10 potential confounders. Masked hypertension was not associated with total weekly work hours.
  
  
  CONCLUSIONS
  Masked hypertension is a significant individual and public health concern. Additional research is needed to clarify the role of work-related risk factors in the development of masked hypertension, and to develop an appropriate clinical and public health strategy for diagnosis, treatment and prevention.
authors.affiliation: Department of Environmental and Occupational Health Sciences, State University of New York-Downstate School of Public Health, 450 Clarkson Ave., Box 43, Brooklyn, NY 11203, USA. paul.landsbergis@downstate.edu
authors.forename: Paul A
authors.initials: PA
authors.lastname: Landsbergis
authors.forename: Arlene
authors.initials: A
authors.lastname: Travis
authors.forename: Peter L
authors.initials: PL
authors.lastname: Schnall
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D003430:Cross-Sectional Studies; D003971:Diastole; D005260:Female; D018576:Home Health Aides / Q000523:psychology; D006801:Humans; D007588:Job Satisfaction; D016015:Logistic Models; D008297:Male; D059468:Masked Hypertension / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology; D008875:Middle Aged; D009784:Occupational Diseases / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology; D016272:Occupational Health; D016017:Odds Ratio; D010561:Personnel Staffing and Scheduling; D010564:Personnel, Hospital / Q000523:psychology; D011237:Predictive Value of Tests; D012307:Risk Factors; D013315:Stress, Psychological / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology; D011795:Surveys and Questionnaires; D013599:Systole; D013997:Time Factors; D016526:Workload / Q000523:psychology; D017132:Workplace / Q000523:psychology*; D055815:Young Adult