Stress-induced arterial hypertension: search for predictors

Background. Despite the existence of a clear cause-and-effect relationship between job strain and hypertension, there are still no clear criteria for defining stress-induced arterial hypertension (SIAH). Objective. Search for SIAH criteria, in particular predictors of hypertension in the workplace. Materials and methods. The study included volunteers experiencing stress in the workplace and not having hypertension. Before the start of the working day and at the end of the working day, the subject was surveyed, given questionnaires (Ch. D. Spielberg scale, Montgomery-Asberg MADRS scale, A. M. Vein scale, hospital anxiety and depression scale HADS), blood pressure and resting heart rate were measured, fasting blood was taken to determine the values of ACTH, TSH, T4, insulin, cortisol. All patients underwent ABPM on a working day and a day off. Results. According to ABPM (n=52), no signs of masked hypertension were detected, however, significant differences between workdays and weekends in the levels of maximum SBP and DBP during the daytime were noteworthy. In the group with maximum SBP>140 mm Hg during the daytime (SIAH, n = 34), on a workday there was an increase in the time index for SBP>30% (24 hours and day), characteristic of hypertension, and for DBP (24 hours and day), characteristic of borderline (possible) hypertension, the average DBP values during the day and at night were at the upper limit of the norm, which was significantly different from the Normotonic group (n = 19). On a weekday, the SIAH group also had significantly increased SBP (24 hours, day) and DBP (24 hours, day and night) indexes versus Normotonic. For all other indicators except ABPM, the groups were comparable. Conclusions. Taking into account the increase in the time index for SBP and DBP, it can be assumed that, against the background of stressful situations at the workplace, the subjects had short frequent increases in blood pressure, which have not yet led to a significant violation of self-regulation of blood pressure and the development of hypertension. An increase in the maximum values of systolic and/or diastolic blood pressure against the background of an increased time index on a working day are possible predictors of SIAH, in particular hypertension at the workplace.