Occupational Status Moderates the Association Between Current Perceived Stress and High Blood Pressure

Although lay beliefs commonly relate high blood pressure (BP) to psychological stress exposure, research findings are conflicting. This study examined the association between current perceived stress and high BP, and explored the potential impact of occupational status on this association. Resting BP was measured in 122 816 adults (84 994 men), aged ≥30 years (mean age±standard deviation: 46.8±9.9 years), without history of cardiovascular and renal disease and not on either psychotropic or antihypertensive drugs. High BP was defined as systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg. Perceived stress in the past month was measured with the 4-item perceived stress scale. A total of 33 154 participants (27.0%) had high BP (151±14/90±9 mm Hg). After adjustment for all variables except occupational status, perceived stress was associated with high BP (odds ratio [OR] for a 5-point increase: 1.06; 95% confidence interval [CI]: 1.03-1.09). This association was no longer significant after additional adjustment for occupational status (OR: 1.01; 95% CI: 0.99-1.04). There was a significant interaction (P<0.001) between perceived stress and occupational status in relation to BP: perceived stress was negatively associated with high BP among individuals of high occupational status (OR: 0.91; 95% CI: 0.87-0.96), but positively associated among those of low status (OR: 1.10; 95% CI: 1.03-1.17) or unemployed (OR: 1.13; 95% CI: 1.03-1.24). Sensitivity analyses yielded similar results. The association between current perceived stress and BP depends on occupational status. This interaction may account for previous conflicting results and warrants further studies to explore its underlying mechanisms.