Ambulatory Monitoring of Blood Pressure in Occupational Hypertension

Background: A physician’s decision to retire has personal and social consequences. While there has been growing interest in how individuals adjust to retirement, less is known about physicians’ adjustment to retirement.

Objectives: To identify and examine: 1) factors that influence how well physicians adjust to retirement; 2) reasons physicians give for retiring; and 3) advice physicians give for a successful adjustment to retirement.

Methods: A systematic review of the literature was performed by searching Medline, Web of Science, Scopus, CINAHL, Ageline, Embase, Health star, ASSA, and PsycINFO databases for peer-reviewed studies published with quantitative and/or qualitative analyses of physicians’ adjustment to, satisfaction with, and/or quality of life in retirement. Two independent reviewers performed data abstraction, a quality assessment and an additional reviewer resolved inconsistencies. Content analysis was used to identify and stratify information from selected studies into themes and subthemes.

Results: Based on analyses of 12 articles that met the eligibility criteria, it is evident that retirement from medicine was seen as a generally favorable phenomenon. Financial security, favorable health, engagement in activities, and psychosocial well-being were identified as key factors relevant to physician retirement adjustment. Findings suggest that physicians’ retirement transitions could be eased by a greater focus on financial planning, implementation of strategies to encourage the development of outside interests, and institutional retirement planning that honors the physician and takes place mid-career or well in advance of retirement.

Conclusions: Advance planning to ensure that physicians have a strong financial situation, good health, engagement in activities outside of medicine, and positive psychosocial dynamics are likely to enhance adjustment to retirement for physicians. Future studies should account for multiple interrelating factors such as gender, changes over time, and spousal retirement to further enhance our understanding of physicians’ adjustment to retirement.

Stress is considered to have a strong impact on changes in blood pressure through overproduction of catecholamines during working hours [1,2].

We are presenting the graphical behavior of blood pressure of two patients. In both cases hypertension is present exclusively during working hours. The first graphic correspond to a 39 year old nurse working 7 hours (Figure 1) and the second one, to a 46 year old engineer working from 8:00 am to 22:00 pm. In the second case, this period also included a two hour-lunch break and nap break.

Figure 1: The graphic shows the presence of hypertension only during the 7 hours period the patient was working (from 8:00 to 15:00 pm).

In the second case, blood pressure remained high during working hours and only went down during lunch time and nap time (Figure 2). Both patients display intellectual work.

Figure 2: The graphic shows the presence of hypertension during a long working day (8:00 am-9:00 pm) with only a slightly decrease at lunch time and nap time.

This pathophysiological situation known as masked hypertension [3] and which seems to increase during periods of economic crisis, is called Occupational Hypertension and correlates to job stress [4].

Blood pressure monitoring was assessed using Cardiorisc Project [5], a protocol elaborated by the Spanish Society of Hypertension. Even low percentages of blood pressure levels when monitoring, are considered to be normal owing to the wide variability of blood pressure, it is not normal that all readings are high during working hours as shown in both graphics.

Normal blood pressure values are:

1. At consultation: <140/90 mmHg

2. Blood pressure ambulatory monitoring: Average ≤130/80 mmHg; waking ≤135/85 mmHg

3. During sleep: ≤120/75 mm/Hg.

1. Landsbergis PA, Travis A, Schnall PL (2013) Working Conditions and Masked Hypertension. High Blood Press Cardiovasc Prev 20: 69-76.
2. Belkić KL, Schnall PL, Landsbergis PA, Schwartz JE, Gerber LM, et al. (2001) Hypertension at the workplace—an occult disease? The need for work site surveillance. Adv Psychosom Med 22: 116–138.
3. Verberk WJ, Kessels AG, de Leeuw PW (2008) Prevalence, causes, and consequences of masked hypertension: a meta-analysis. Am J Hypertens 21: 969–975. 
4. Peña Betancourt MC, Rodríguez Nande LM, de la Noval García R, Dueñas Herrera AF, Román Hernández JJ, et al. (2011) Tensión laboral y presión arterial. Revista Cubana de Cardiología y cirugía cardiovascular 17:
5. www.cardiorisc.com.