Blood pressure (hypertension) & Fitness for work
Hypertension
Hypertension is the medical term for high blood pressure. Hypertension increases the risk of blood vessel disease resulting in long term complications such as stroke, heart attack, eye disease and kidney disease. Generally, the higher the blood pressure, the higher the long term risk. Conversely, the lower the blood pressure, the lower the long term risk. There is no single blood pressure cut off level that divides people into 'safe' and 'unsafe'.
Hypertension & fitness for work
Hypertension affects fitness for work because of the risk of sudden incapacity from a stroke or heart attack. It is important to keep in mind that high blood pressure is only one of the risk factors for a stroke or heart attack. Other important risk factors are:
- Previous stroke/heart attack
- Age
- Gender
- Family history of heart disease
- High cholesterol
- Smoking
- Diabetes
- Obesity
- Lack of physical activity
The other way hypertension affects fitness for work is when the use of anti-hypertensive medication causes side-effects such as dizziness, nausea or fatigue. The risk for side-effects is greatest in the first few days of starting or changing medication. Patients are cautioned about this by their treating doctors. Generally, modern anti-hypertensive medications cause no side-effects in most people with regular use.
Assessing fitness for work - minimising the risk
The risk of sudden incapacity from a blood pressure of 160/80 in a young female is different from a blood pressure of 160/80 in an elderly male smoker with high cholesterol and diabetes. Therefore, fitness for work cannot be determined by a single blood pressure reading alone. The overall risk needs to be considered and this occurs when the other risk factors listed above are reviewed together. The risk is minimised by ongoing medical review and risk factor management.
As a rule, only a blood pressure reading of 200/110 or above is an automatic bar to immediate employment. This is because it is associated with a high risk of short term complications.
White coat hypertension
White coat hypertension occurs when a person with usually normal blood pressure has a high pressure reading measured whenever he sees a doctor (usually because of stress!). White coat hypertension occurs commonly at preplacement medicals. To differentiate between true hypertension and white coat hypertension, a person usually has to undergo periodic monitoring and sometimes 24 hour ambulatory blood pressure monitoring. Practically, this means referral to the person's own doctor for ongoing follow-up.
Dr. Roger Lai
MBBS (Hons)
Occupational Medicine Registrar
OccuMED Consulting
|