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Psychosocial Predictors of Hypertension in Men and Women
Susan Levenstein, MD;
Margot W. Smith, DrPH;
George A. Kaplan, PhD
Arch Intern Med. 2001;161:1341-1346.
Background Psychosocial stressors have been shown to predict hypertension in several
cohort studies; patterns of importance, sex differences, and interactions
with standard risk factors have not been fully characterized.
Methods Among 2357 adults in a population sample of Alameda County, California,
free of hypertension in 1974, 637 reported in 1994 having ever used antihypertensive
medication (27.9% of the men and 26.3% of the women). The effects of baseline
psychosocial, behavioral, and sociodemographic factors on the incidence of
treated hypertension were examined using multiple logistic regression.
Results Low education, African American race, low occupational prestige, worry
about job stability, feeling less than very good at one's job, social alienation,
and depressive symptoms each had significant (P<.05)
age-adjusted associations with incident hypertension. Associations were weakened
by adjustment for body mass index, alcohol consumption, smoking status, and
leisure time physical activity, especially the associations of anomy and depression,
which persisted in women but not in men. In multivariate models, job insecurity
(odds ratio, 1.6), unemployment (odds ratio, 2.7), and low self-reported job
performance (odds ratio, 2.1) remained independent predictors of hypertension
in men, whereas low-status work (odds ratio, 1.3) was an independent predictor
of hypertension in women.
Conclusions In the general population, low occupational status and performance and
the threat or reality of unemployment increase the likelihood of developing
hypertension, especially among men, independent of demographic and behavioral
risk factors. Psychological distress and social alienation may also increase
hypertension incidence, especially in women, chiefly through an association
with health risk behaviors.
From the Human Population Laboratory, Berkeley, Calif (Drs Levenstein
and Smith), and the Department of Epidemiology, University of Michigan, Ann
Arbor (Dr Kaplan).
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