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Cardiovascular Reactivity to Work Stress Predicts Subsequent Onset of Hypertension: The Air Traffic Controller Health Change Study

From the Department of Epidemiology, Harvard School of Public Health, Boston, MA (E.E.M.); Department of Medicine, Harvard Medical School, Boston, MA (G.K.A.); Department of Health Care Policy, Harvard Medical School, Boston, MA (R.C.K.); Department of Psychiatry, Rush-Presbyterian-St. Luke’s Medical Center, Chicago, IL (L.F.F.); Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA (K.A.M.); Department of Medicine, Baylor College of Medicine, Houston, TX (J.A.H.); and Program on Human and Community Development, The John D. and Catherine T. MacArthur Foundation, Chicago, IL (R.M.R.).

Address correspondence and reprint requests to Robert M. Rose, MD, Mind Brain Body and Health Initiative, 2.210 Ashbel Smith Building, Institute for the Medical Humanities, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-1311. E-mail: brose{at}urbancom.net

OBJECTIVE: The hypothesis that increased blood pressure reactivity to stress is an early risk marker of hypertension was tested in a 1994 follow-up of the 1974 to 1978 Air Traffic Controller Health Change Study sample.

METHODS: Assessments in 1974 to 1978 included physical examinations and recordings (every 20 minutes for 5 hours) of both workload (planes within controller airspace) and blood pressure reactivity. Individual differences in reactivity were used to predict 1994 self-report of ever having been told by a physician to take antihypertensive medication, assessed in a telephone survey of 218 respondents who were normotensive or stage 1 hypertensive in 1974 to 1978.

RESULTS: Each SD increase in baseline systolic reactivity was associated with a 1.7 (p < .019) increase in the relative-odds of 1994 hypertension, after controlling for age, body mass index, and clinic systolic and diastolic blood pressure at clinical examination, with effects comparable for baseline normotensives and stage 1 hypertensives.

CONCLUSION: A 20-year follow-up of originally normotensive and stage I hypertensive workers suggests that increased systolic blood pressure reactivity to work stress is associated with long-term risk of hypertension.

Key Words: cardiovascular reactivity, • epidemiology, • hypertension, • prevention, • screening.

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