Isolated Diastolic Hypertension

Isolated diastolic hypertension is having BP less than 140 but greater than 90. This has been more responsive to treatment.
Isolated diastolic hypertension has better prognosis in younger people.

JAMA Guidelines for Treatment of Hypertension

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Some points highlighted from the report:

• In persons older than 50 years, systolic blood pressure (BP) of more than 140 mm Hg is a much more important cardiovascular disease (CVD) risk factor than diastolic BP
• Stage 1 Hypertension: 140-159/90-99; Treatment: Thiazide-type diuretics should be used as initial therapy for most patients with hypertension, either alone or in combination with 1 of the other classes (ACE inhibitors, ARBs, {beta}-blockers, CCBs)

Job Stress & Incidence of Coronary Events Studies

The most recent review shows a significant relationship between job strain and heart disease ..
Belkic KL, Landsbergis PA, Schnall PL, et al. Is job strain a major source of cardiovascular disease risk? Scand J Work Environ Health 2004;30:85–128.[Web of Science][Medline]
" Empirical studies on job strain and cardiovascular disease (CVD), their internal validity, and the likely direction of biases were examined. The 17 longitudinal studies had the highest validity ratings. In all but two, biases towards the null dominated. Eight, including several of the largest, showed significant positive results; three had positive, nonsignificant findings. Six of nine case-control studies had significant positive findings; recall bias leading to overestimation appears to be fairly minimal. Four of eight cross-sectional studies had significant positive results. Men showed strong, consistent evidence of an association between exposure to job strain and CVD. The data of the women were more sparse and less consistent, but, as for the men, most of the studies probably underestimated existing effects. Other elements of causal inference, particularly biological plausibility, corroborated that job strain is a major CVD risk factor."

Belgian study did not find a strong correlation between job stress and the incidence or coronary events. The authors of the study concede that .." a possible explanation for the differences between our findings and those from previous studies may be the relatively short follow-up of 3 years on average."

Stress and hypertension

Hypertension is defined to be a systolic blood pressure of greater than 139 mm Hg or a diastolic blood pressure of greater than 89 mm Hg.

What is stress - components of stress:

• depression, anxiety, panic disorder;
• social isolation and lack of quality social support;
• acute and chronic life events;
• psychosocial work characteristics;
  
• Type A behaviour, hostility.

References:

• Mental stress as a causal factor in the development of hypertension and cardiovascular disease. Pickering TG. Curr Hypertens Rep. 2001 Jun;3(3):249-54. "...Job strain, which is defined as a combination of low control and high demands at work, has been associated with increased blood pressure and coronary heart disease outcomes, particularly in men. "
• Stress and hypertension. Kulkarni S, O'Farrell I, Erasi M, Kochar MS. WMJ. 1998 Dec;97(11):34-8. Medical College of Wisconsin, Milwaukee, USA. "Although stress may not directly cause hypertension, it can lead to repeated blood pressure elevations, which eventually may lead to hypertension."
• Increases in job strain are associated with incident hypertension in the CARDIA Study. Markovitz JH, Matthews KA, Whooley M, Lewis CE, Greenlund KJ. Ann Behav Med. 2004 Aug;28(1):4-9.
• Impact of job and marital strain on ambulatory blood pressure results from the double exposure study. Tobe SW, Kiss A, Szalai JP, Perkins N, Tsigoulis M, Baker B. Am J Hypertens. 2005 Aug;18(8):1046-51."... Psychosocial factors may influence the development of early hypertension."
• Job strain in men, but not in women, predicts a significant rise in blood pressure after 6.5 years of follow-up. Ohlin B, Berglund G, Rosvall M, Nilsson PM. J Hypertens. 2007 Mar;25(3):525-31."Job strain significantly predicts an increase in office blood pressure in middle-aged men, but not in women."
• A longitudinal study of job strain and ambulatory blood pressure: results from a three-year follow-up. Schnall PL, Schwartz JE, Landsbergis PA, Warren K, Pickering TG. Psychosom Med. 1998 Nov-Dec;60(6):697-706. "This study was conducted to investigate the hypothesis that exposure to "job strain" is related to increased ambulatory blood pressure (ABP). METHOD: Participants were 195 men who wore an ABP monitor for 24 hours on two occasions 3 years apart....The group repeatedly exposed to job strain had higher levels of ABP at Time 2 than either crossover group. Furthermore, change in job strain status partially predicted change in ABP. These results provide new evidence supporting the hypothesis that job strain is an occupational risk factor in the etiology of essential hypertension."