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BACKGROUND: Cardiovascular diseases are the most important cause of death and invalidity during the course of working life. The major risk factor for cardiovascular diseases is arterial hypertension, a typical example of multifactorial and polygenic disease, involving genetic, environmental, and demographic factors. OBJECTIVES: A review of studies performed sofar on hypertension which can be also defined as a work-related disease. METHODS: Several studies on association or linkage analysis showed an association between genetic polymorphisms and increased risk of hypertension. RESULTS: Till now no studies have identified one or more "major" candidate genes involved in the pathogenesis of hypertension. Recently the interaction between genetics and environment have attracted much interest since the genotypes predisposingfor hypertension have different effects according to the patient's environment and life style. CONCLUSIONS: It is likely that the aspects covered in this review will, in the near future, be studied more extensively. The identification of any correlations between genes and environment will also be influenced by the accuracy in measuring environmental exposure, where the occupational physician will play a significant role.

The aim is to assess socio-occupational (SO) class differences in incident coronary and stroke. Methods. In a prospective fixed-cohort study 2959 35-74 year old men free from coronary (CHD) and stroke events were recruited in four population-based cohorts from 1986 to 1994 and followed-up until the end of 2002 to ascertain first CHD and stroke events. At baseline, major cardiovascular risk factors were investigated according to a standardised protocol. SO classes were based on current or last employment. Age-adjusted and multi-factors-adjusted risk ratios (RR) and 95% CI were calculated from Poisson regression models. Results. In 11-year median follow-up, the cohorts accumulated 33,926 person-years and generated 168 first major CHD events and 56 stroke events. Non-manual workers showed the lowest incident rates of both endpoints, and were considered as the reference category. Higher relative risks of CHD events were foundfor lower administrators and professionals, unskilled manual workers (UMW) and self-employed. Higher relative risks of stroke were found for skilled manual workers and UMW. Higher relative risks of CVD (either CHD or stroke) were found for lower administrators and professionals, skilled and unskilled manual workers and self-employed. Adjustments for major risk factors (cholesterol, systolic blood pressure, cigarette smoking, diabetes) did not modify the RRs. Conclusion. The higher risk of major cardiovascular events among lower SO classes is confirmed. Higher relative risks of CHD among lower administrators and professionals, and self-employers were also found. Further studies are needed to assess the etiologic role of job stress conditions.

Background. Previously reported time trends of myocardial infarction rates in the MONICA Brianza 35-64-year-old population showed a clear decline in coronary heart disease mortality, mostly attributable to concurrent reductions in myocardial infarction attack rates, and to a lesser extent in 28-day case fatality. The aims of this study were to estimate time trends in more recent years (up to 1997-1998) in the same population and in the same age range, and to assess the impact of myocardial infarction among 35-74-year-old residents, an age range never investigated before in Italy using standardized population-based registers. Methods. The myocardial infarction register in the Brianza population was resumed in 1997-1998, adopting the same standardized methods for data collection and classification of suspect coronary events as the WHO MONICA project, including the age group 65-74 years in addition to age groups usually covered. Age-specific and age-standardized rates of validated coronary mortality rates, of attack rates, and incidence rates and of 28-day case fatality were calculated. Time changes were estimated as the difference in rates. Results. In comparison to the rates among 35-64-year-old residents, the 35-74 age-standardized rates of coronary event mortality in the biennium are more than 3 times higher in women and more than twice in men. Similarly, the attack and incidence rates increased respectively from 243 to 381 and from 197 to 292 per 100 000 in men, from 38 to 107 and from 33 to 87 per 100 000 in women. Statistically significant reductions are observed in coronary death rates, myocardial infarction attack rates and 28-day case-fatality rates between 1993-1994 and 1997-1998 in men. Analogous but not statistically significant changes are reported for women. Conclusions. In the Brianza MONICA population in the second half of the 1990s, coronary event death rates continued to decrease. In contrast with trends observed in previous years, the prominent quot

Although ambulatory blood pressure monitoring is gaining in popularity, it still has important limitations in clinical use, particularly for the definition and diagnosis of hypertension. Various attempts have been made to calculate 'normal' or 'reference' values for ambulatory blood pressure, mostly by 24-h non-invasive monitoring in groups of 'normal' subjects. The most appropriate approach, however, is to compare 24-h ambulatory blood pressure values and casual or clinic blood pressure values in a random sample of a suitably large population. The PAMELA Study has been planned to obtain an epidemiological evaluation of 24-h ambulatory blood pressure values, and its design is described here. In the city of Monza, 2400 subjects aged between 25 and 64 years have been randomly selected according to World Health Organization Monitoring Cardiovascular Diseases (WHO-MONICA) project criteria within sex and age strata. In these subjects, clinic blood pressure, random-zero blood pressure, ambulatory blood pressure (24-h monitoring with SpaceLabs 90207; Redmond, Washington, USA), home blood pressure, electrocardiographic and echocardiographic indices, cardiovascular risk factors and psychological variables are being measured.