A structured interview concerning emotional coping patterns was administered to 63 28-year-old men included in a psychophysiological study of blood pressure elevation. The interviews were tape recorded and subsequently evaluated by a rater not otherwise involved in the study. The interviews involved discussion of four emotions: anger, sorrow, anxiety, and joy. The results indicate that normotensives can express sorrow to significantly more people than hypertensives, and that their behavior in situations involving sorrow tends to be more instrumental than that of the group with labile pressure. Hypertensives also experienced significantly less joy than normotensives. In multiple regression analyses on physiological variables relevant for blood pressure elevation, the use of a somatic and unfocused way of describing sorrow was associated with significantly lower heart rate. The results show also that emotional coping explains a significant amount of the variance in three of the psychosocial functions involved in elevated blood pressure: ability to express anger at work, plus the social support variables of attachment and acquaintance.

Men who had high, medium and low blood pressure at age 18 (compulsory screening for military service in Stockholm) were examined ten years later at age 28. Interviewers, having had no information regarding past or present blood pressure, interviewed them about life events experienced during the year preceding the examination. Men with high blood pressure at rest reported fewer life events for the past year than other men. Furthermore, high plasma adrenaline levels at rest were associated with few reported life events.

During an ordinary work day blood pressure was self-monitored once every hour in two samples of asymptomatic nonmedicating 28-year-old men. They were selected on the basis of previous compulsory blood pressure recordings made at the age of 18 when they had been drafted for military service. Subjects in the "original hypertensive sample" with "strain" occupations (hectic and uncontrollable, such as waiter, driver and cook) had more marked elevations of systolic blood pressure during work hours than other subjects.

The object of the present study was to examine the interaction of working environment factors and the individual social support network with medical variables related to blood pressure elevations in young (mean age = 28 years) hypertensives. The results of path analyses reveal that the medical variables which explained a significant amount of the variation in systolic blood pressure were blood hemoglobin, plasma adrenaline and relative weight. High relative weight was associated with a low level of employment security and high plasma adrenaline with a poor self-reported social network as well as a job providing few possibilities for learning new things. High levels of diastolic pressure were associated with elevated hemoglobin levels, increased heart rate and low plasma renin activity. Increased heart rate was influenced by a lack of ‘anger’ coping in conflict situations at work and a low number of contacts with acquaintances. Working environment and social support are hypothesized to assert their influence through increased sympathetic stimulation mediated by limbic-hypothalamic discharge.

The interrelationships between psychosocial factors, several physiological variables and blood pressure (BP) were investigated in 88 young men (aged 26-32 years) in whom high, intermediate or low BP had been recorded at the age of 18 years. In the original high BP group, venous plasma noradrenaline was normal but adrenaline levels elevated. At the follow-up adrenaline correlated with systolic blood pressure (SBP), and this was also so after controlling for overweight and serum gamma-glutamyltranspeptidase [gamma-GT, a marker for alcohol consumption, which showed an independent association with diastolic blood pressure (DBP)]. Low assertiveness (low scores of verbal and indirect aggression) correlated with high BPs, even after controlling for other psychosocial variables. Several associations between psychosocial job variables and physiological variables were found. Among self-reported job variables, excessive 'demands' and 'bossing others' (but not 'decision latitude' or 'psychosocial conflict') were associated with high SBP. Habitual smoking of cigarettes was not associated with BP at rest, but influenced several associations between psychosocial and physiological variables. Men with high BP at rest and low plasma renin activity (PRA) reported more psychosocial problems at work and lower assertiveness than other groups.

This article summarizes some of the major findings in research on associations between psychosocial factors and cardiovascular illness. Methodological difficulties are discussed. Findings from some of the authors' own studies serve as illustrations. It is emphasized that an interplay between environmental and individual factors is of great importance. Personality factors relevant to the risk of cardiovascular illness may distort individual descriptions of the work environment. Cardiovascular risk factors such as cigarette smoking and repeated blood pressure elevations may be influenced by psychosocial factors. Lack of intellectual discretion at work, particularly if combined with excessive demands, may increase the risk of cardiovascular illness.

During the past 20 years, a great deal of research has been conducted concerning the adverse effects of working environment on health. These studies can be divided into two main groups: 1) epidemiological investigations of the incidence of illness associated with different types of jobs and 2) studies correlating self- report measures of the working environment with different indices of ill health. Despite the considerable contribution made by both of these approaches, attempts to draw conclusions by summing their results, has lead to contradictions. The present study is an attempt to combine both methods in order to analyze the effect of working environment on blood pressure and blood pressure variations in young men from the general population.