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Results of a Case-Control Study

Peter L. Schnall, MD, MPH; Carl Pieper, DrPH; Joseph E. Schwartz, PhD; Robert A. Karasek, PhD; Yvette Schlussel, PhD; Richard B. Devereux, MD; Antonello Ganau, MD; Michael Alderman, MD; Katherine Warren; Thomas G. Pickering, MD, DPhil

JAMA. 1990;263(14):1929-1935.

Abstract
To determine whether "job strain" (defined as high psychological demands and low decision latitude on the job) is associated with increased workplace diastolic blood pressure and the left ventricular mass index, we conducted a case-control study at seven urban work sites of 215 employed men aged 30 to 60 years without evidence of coronary heart disease. After comprehensive blood pressure screening of male employees (N = 2556) at the work site, 87 cases of hypertension and a random sample of 128 controls were studied. In a multiple logistic regression model, job strain was significantly related to hypertension, with an estimated odds ratio of 3.1, after adjusting for age, race, body-mass index, type A behavior, alcohol intake, smoking, work site, 24-hour urine sodium excretion, education, and physical demand level of the job. Controlling for the above variables in subjects aged 30 to 40 years with job strain, we found that the echocardiographically determined left ventricular mass index was, on average, 10.8 g/m² greater than in subjects without job strain. We conclude that job strain may be a risk factor for both hypertension and structural changes of the heart in working men.

(JAMA. 1990;263:1929-1935)

Author Affiliations
From the Cardiovascular and Hypertension Center, New York Hospital-Cornell Medical College, New York, NY (Drs Schnall, Pieper, Karasek, Schlussel, Devereux, Ganau, and Pickering and Ms Warren); the Department of Psychiatry, State University of New York at Stony Brook (Dr Schwartz); and the Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY (Dr Alderman).

Footnotes
Reprint requests to Hypertension Center, Starr Pavilion ST416, Cornell University Medical College, 525 E 68th St, New York, NY 10021 (Dr Schnall).

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