Psychosocial predictors of hypertension in men and women

Background: Psychosocial stressors have been shown to predict hypertension in several cohort studies; patterns of importance, sex differences, and int eractions with standard risk factors have not been fully characterized. Methods: Among 2357 adults in a population sample of Alameda County, Califo rnia, free of hypertension in 1974, 637 reported in 1994 having ever used a ntihypertensive medication (27.9% of the men and 26.3% of the women). The e ffects of baseline psychosocial, behavioral, and sociodemographic factors o n the incidence of treated hypertension were examined using multiple logist ic regression. Results: Low education, African American race, low occupational prestige, w orry about job stability, feeling less than very good at one's job, social alienation, and depressive symptoms each had significant (P < .05) age-adju sted associations with incident hypertension. Associations were weakened by adjustment for body mass index, alcohol consumption, smoking status, and l eisure time physical activity, especially the associations of anomy and dep ression, which persisted in women but not in men. In multivariate models, j ob insecurity (odds ratio, 1.6), unemployment (odds ratio, 2.7), and low se lf-reported job performance (odds ratio, 2.1) remained independent predicto rs 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 perform ance and the threat or reality of unemployment increase the likelihood of d eveloping hypertension, especially among men, independent of demographic an d behavioral risk factors. Psychological distress and social alienation may also increase hypertension incidence, especially in women, chiefly through an association with health risk behaviors.