According to a study published in the European Journal of Preventive Cardiology, which is associated with the European Society of Cardiology (ESC), a threefold increase in the risk of cardiovascular death has been linked to work stress and poor sleep in employees with high blood pressure.

“Sleep should be a time for recreation, unwinding, and restoring energy levels. If you have stress at work, sleep helps you recover. Unfortunately, poor sleep and job stress often go hand in hand, and when combined with hypertension the effect is even more toxic,” states Professor Karl-Heinz Ladwig of the German Research Centre for Environmental Health and the Medical Faculty at the Technical University of Munich, the lead author of the study.  “They wake up at 4 o’clock in the morning to go to the bathroom, for example, and come back to bed ruminating about how to deal with work issues.”

Approximately one-third of employed individuals suffer from hypertension or high blood pressure. Previous studies have indicated that psychosocial factors have a greater negative impact on individuals with existing cardiovascular risks than on those who are healthy. This study is the first to investigate the combined impact of work stress and poor sleep on the risk of death from cardiovascular disease in workers with hypertension.

The study involved 1,959 workers with hypertension aged 25-65, who did not have any prior history of cardiovascular disease or diabetes. Results showed that those with both work stress and sleep disturbances had a threefold increased risk of dying from cardiovascular disease compared to those with no work stress and good sleep. Meanwhile, workers who had only work stress had 1.6 times higher risk, and those with only poor sleep had a 1.8 times higher risk.

Over a nearly 18-year follow-up period, the likelihood of cardiovascular death in hypertensive workers increased progressively with each additional factor. The absolute risk of cardiovascular death was 7.13 per 1,000 person-years for employees who experienced both work stress and poor sleep, compared to 3.05 per 1,000 person-years for those without stress and who slept well. The absolute risk of cardiovascular death was 4.99 per 1,000 person-years for those who experienced work stress only, and 5.95 per 1,000 person-years for those who had only poor sleep.

The study defined work stress as jobs that are characterized by high demands and low control. For instance, jobs where an employer has high expectations but denies employees decision-making authority. According to Professor Ladwig, having high demands but also high control, meaning employees have decision-making power, can even be beneficial for health. On the other hand, being stuck in a stressful situation where one has no power to make changes can be harmful.

Lead researcher Professor Ladwig urges that these results findings are indicative for doctors to discuss their work-life balance with hypertensive patients. “Each condition is a risk factor on its own and there is cross-talk among them, meaning each one increases risk of the other. Physical activity, eating healthily, and relaxation strategies are important, as well as blood pressure lowering medication if appropriate.”  Based on the results of the study, employers should consider implementing stress management and sleep treatment programs in the workplace, particularly for those with chronic conditions like high blood pressure.


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