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      The relation of work-related factors with ambulatory blood pressure and nocturnal blood pressure dipping among aging workers

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          Abstract

          Objectives

          Individuals with reduced nocturnal blood pressure (BP) dipping are at increased risk of cardiovascular disease compared to persons with normal BP dipping. Although the relation of work-related factors and BP has been studied extensively, very little is known of the association between work-related factors and 24-h BP patterns in aging workers. We examined the cross-sectional relation of work-related risk factors, including occupational status, work-time mode, job demands and job control, with ambulatory BP in aging workers, focusing on nocturnal BP dipping.

          Methods

          208 workers (mean age 62 ± 3 years; 75% women) from two Finnish population-based cohort studies underwent 24-h ambulatory BP monitoring. Work-related factors were inquired using a questionnaire. Nocturnal BP dipping was calculated as [1 − (asleep BP/awake BP)] × 100.

          Results

          Shift workers demonstrated a higher nocturnal diastolic BP dipping than regular day workers (19% vs. 17%, p = 0.03) and had a significantly higher systolic awake BP than regular day workers (136.5 mmHg vs. 132.5 mmHg, p = 0.03). Participants with high job demands demonstrated a smaller nocturnal systolic BP dipping than participants with low job demands (14% vs. 16%, p = 0.04). We did not observe significant differences in nocturnal systolic or diastolic BP dipping between groups categorized by occupational status or job control.

          Conclusions

          Although shift workers have a higher daytime BP than regular daytime workers, they exhibit greater nighttime BP dipping. Participants with high job demand had smaller nighttime BP dipping than participants with low job demand. Job control or occupation did not affect the 24-h ambulatory BP profile of aging workers.

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          Most cited references31

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          Ambulatory blood pressure and 10-year risk of cardiovascular and noncardiovascular mortality: the Ohasama study.

          The objective of this study was to elucidate the long-term prognostic significance of ambulatory blood pressure. Ambulatory and casual blood pressure values were obtained from 1332 subjects (872 women and 460 men) aged >or=40 years from the general population of a rural Japanese community. Survival was then followed for 14 370 patient years and analyzed by a Cox hazard model adjusted for possible confounding factors. There were 72 cardiovascular deaths during the 10.8-year follow-up. The relationship between 24-hour systolic blood pressure and the cardiovascular mortality risk was U-shaped in the first 5 years, then changed to J-shaped over the rest of the 10.8-year follow-up. After censoring the first 2 years of data, the risk flattened until it again increased for the fifth quintile of 24-hour systolic blood pressure for the 10.8-year follow-up period. For 24-hour diastolic blood pressure, the J-shaped relationship remained unchanged, regardless of follow-up duration and censoring. Ambulatory systolic blood pressure values consistently showed stronger predictive power for cardiovascular mortality risk than did casual systolic blood pressure in the 10.8-year follow-up data, whereas such relationships became more marked after censoring the first 2 years. When nighttime and daytime systolic blood pressure values were simultaneously included in the same Cox model, only nighttime blood pressure significantly predicted the cardiovascular mortality risk for the 10.8-year follow-up data. We conclude that the relationship between ambulatory systolic blood pressure and cardiovascular mortality is not U-shaped or J-shaped, and that nighttime blood pressure has better prognostic value than daytime blood pressure.
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            Circadian clock-mediated regulation of blood pressure

            Most bodily functions vary over the course of a 24 hour day. Circadian rhythms in body temperature, sleep-wake cycles, metabolism, and blood pressure (BP) are just a few examples. These circadian rhythms are controlled by the central clock in the suprachiasmatic nucleus (SCN) of the hypothalamus and peripheral clocks located throughout the body. Light and food cues entrain these clocks to the time of day and this synchronicity contributes to the regulation of a variety of physiological processes with effects on overall health. The kidney, brain, nervous system, vasculature, and heart have been identified through the use of mouse models and clinical trials as peripheral clock regulators of BP. The dysregulation of this circadian pattern of BP, with or without hypertension, is associated with increased risk for cardiovascular disease. The mechanism of this dysregulation is unknown and is a growing area of research. In this review, we highlight research of human and mouse circadian models that has provided insight into the roles of these molecular clocks and their effects on physiological functions. Additional tissue-specific studies of the molecular clock mechanism are needed, as well as clinical studies including more diverse populations (different races, female patients, etc.), which will be critical to fully understand the mechanism of circadian regulation of BP. Understanding how these molecular clocks regulate the circadian rhythm of BP is critical in the treatment of circadian BP dysregulation and hypertension.
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              Decreasing sleep-time blood pressure determined by ambulatory monitoring reduces cardiovascular risk.

              We investigated whether reduced cardiovascular risk is more related to the progressive decrease of asleep or awake blood pressure. Independent studies have concluded that elevated sleep-time blood pressure is a better predictor of cardiovascular risk than awake or 24-h blood pressure means. However, the impact on cardiovascular risk of changes in these ambulatory blood pressure characteristics has not been properly investigated. We prospectively studied 3,344 subjects (1,718 men and 1,626 women), 52.6 ± 14.5 years of age, during a median follow-up of 5.6 years. Those with hypertension at baseline were randomized to ingest all their prescribed hypertension medications upon awakening or ≥1 of them at bedtime. Blood pressure was measured for 48 h at baseline and again annually or more frequently (quarterly) if treatment adjustment was required. With data collected at baseline, when asleep blood pressure was adjusted by awake mean, only the former was a significant predictor of outcome in a Cox proportional hazards model also adjusted for sex, age, and diabetes. Analyses of changes in ambulatory blood pressure during follow-up revealed a 17% reduction in cardiovascular risk for each 5-mm Hg decrease in asleep systolic blood pressure mean (p < 0.001), independently of changes in any other ambulatory blood pressure parameter. The sleep-time blood pressure mean is the most significant prognostic marker of cardiovascular morbidity and mortality. Most importantly, the progressive decrease in asleep blood pressure, a novel therapeutic target that requires proper patient evaluation by ambulatory monitoring, was the most significant predictor of event-free survival. (Prognostic Value of Ambulatory Blood Pressure Monitoring in the Prediction of Cardiovascular Events and Effects of Chronotherapy in Relation to Risk [the MAPEC Study]; NCT00295542). Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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                Author and article information

                Contributors
                sekkar@utu.fi
                Journal
                Int Arch Occup Environ Health
                Int Arch Occup Environ Health
                International Archives of Occupational and Environmental Health
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                0340-0131
                1432-1246
                31 December 2019
                31 December 2019
                2020
                : 93
                : 5
                : 563-570
                Affiliations
                [1 ]GRID grid.1374.1, ISNI 0000 0001 2097 1371, Department of Internal Medicine, , University of Turku, ; Turku, Finland
                [2 ]GRID grid.1374.1, ISNI 0000 0001 2097 1371, Department of Public Health, , University of Turku, ; Turku, Finland
                [3 ]GRID grid.1374.1, ISNI 0000 0001 2097 1371, Centre for Population Health Research, , University of Turku and Turku University Hospital, ; Turku, Finland
                [4 ]GRID grid.7737.4, ISNI 0000 0004 0410 2071, Clinicum, Faculty of Medicine, , University of Helsinki, ; Helsinki, Finland
                [5 ]GRID grid.14758.3f, ISNI 0000 0001 1013 0499, Department of Public Health Solutions, , National Institute for Health and Welfare, ; Helsinki, Finland
                [6 ]GRID grid.1374.1, ISNI 0000 0001 2097 1371, Paavo Nurmi Centre & Department of Health and Physical Activity, , University of Turku, ; Turku, Finland
                [7 ]GRID grid.410552.7, ISNI 0000 0004 0628 215X, Division of Medicine, , Turku University Hospital, ; Turku, Finland
                Author information
                http://orcid.org/0000-0002-3957-1746
                Article
                1510
                10.1007/s00420-019-01510-8
                7260250
                31893291
                352899ea-500e-461e-8771-1290b59e10f6
                © The Author(s) 2019

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 19 April 2019
                : 18 December 2019
                Funding
                Funded by: Urmas Pekkala Foundation
                Funded by: the Hospital District of Southwest Finland
                Funded by: the Academy of Finland
                Award ID: 286294
                Award ID: 294154
                Award Recipient :
                Funded by: the Eemil Aaltonen Foundation
                Funded by: FundRef http://dx.doi.org/10.13039/100008723, Suomen Lääketieteen Säätiö;
                Funded by: FundRef http://dx.doi.org/10.13039/501100008484, Paavo Nurmen Säätiö;
                Categories
                Original Article
                Custom metadata
                © Springer-Verlag GmbH Germany, part of Springer Nature 2020

                Occupational & Environmental medicine
                job control,job demand,job strain,occupational status,shift work,work-time mode

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