Psychosocial stress in relation to blood pressure and cardivascular disease - epidemiological and genetic aspects

Research output: ThesisDoctoral Thesis (compilation)


Psychosocial stress has been linked to both hypertension and cardiovascular disease

(CVD), and hypertension has been proposed to be one mediator of the increased CVD

risk in subjects reporting stress. Genetic susceptibility for blood pressure elevation in

relation to stress has been proposed, but so far there is little evidence. We aimed to

study the prospective CVD risk of chronic stress (Paper I), and the prospective effect on

blood pressure levels of work-related stress (Paper II). In Papers III-IV the aim was to

explore a hypothesised work stress?gene interaction in relation to blood pressure.

In Paper I, 13,306 participants (2741 women) from the population-based screening and

intervention programme Malmö Preventive Project were followed for a median of 21

years. Men and women with self-reported chronic stress at baseline suffered an

increased risk of cardiovascular events compared to those without baseline stress (RR

1.27; 95%CI 1.15-1.27). The statistical significances were stronger in men than in


In Papers II-IV different sub-cohorts from the population-based Malmö Diet and Cancer

Study (MDCS) were included. Work stress was assessed according to the Karasek

demand-control model. In Paper II, men with baseline job strain (?stress?) had a

significantly greater systolic blood pressure (SBP) and diastolic blood pressure (DBP)

elevation at follow-up compared to men with relaxed working conditions (significance for

difference; SBP p= 0.025, DBP p=0.003, adjustments for age and follow-up time). In

women, baseline job strain was associated with higher blood pressures at baseline, but

no significant differences in blood pressure changes between groups with different work

characteristics were seen at follow-up.

In Paper III, an I/D polymorphism in the adrenergic ?2B-receptor was studied in women

and men (n=2964). Men with the DD-variant of the receptor and job strain had higher

SBP and DBP than all other gene?work characteristic combinations. The interaction

between the DD polymorphism and job strain was significant; p=0.008 for SBP, and

p=0.03 for DBP, adjusted for age, body mass index, occupational status and country of

birth. The decision latitude dimension was more influential than the demand dimension.

In Paper IV, an interaction between work characteristics and the Arg389Gly

polymorphism in the ?1-adrenergic receptor in relation to blood pressure levels was

studied, with significant findings in men.

Our findings confirm previous results of the detrimental effects of chronic stress on the

prospective CVD risk. The findings in Paper II indicate that elevation of blood pressure

in men might mediate the increased CVD risk. For the first time, significant interactions

between genetic factors and job stress, associating with elevated blood pressures, have

been described. If these findings hold true in further research, they provide a new

understanding of the mechanisms of stress, with potential implications for



  • Bertil Öhlin
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Clinical Medicine


  • Kardiovaskulära systemet, receptor, Cardiovascular system, Medicin (människa och djur), Medicine (human and vertebrates), adrenergic, alpha-2, beta-1, mortality, morbidity, prospective, studies, polymorphism, work, stress, blood pressure, hypertension
Original languageEnglish
Awarding Institution
Supervisors/Assistant supervisor
Award date2007 Jun 8
  • Department of Clinical Sciences, Lund University
Print ISBNs978-91-85559-79-4
Publication statusPublished - 2007
Publication categoryResearch

Bibliographic note

Defence details Date: 2007-06-08 Time: 13:00 Place: Aulan, Medicinska kliniken, Entrance 35, University Hospital, Malmö External reviewer(s) Name: Thelle, Dag Title: Prof. Affiliation: Oslo, Norway ---