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Firefighters’ Blood Pressure and Employment Status on Hazardous Materials Teams in Massachusetts: A Prospective Study

Kales, Stefanos N. MD, MPH; Soteriades, Elpidoforos S. MD, MSc; Christoudias, Stavros G. BS; Tucker, Scott A.; Nicolaou, Michael BA; Christiani, David C. MD, MPH, MS

Journal of Occupational and Environmental Medicine: July 2002 - Volume 44 - Issue 7 - p 669-676

We evaluated the association between hypertension and changes in employment status in 334 hazardous materials firefighters. Firefighters were categorized by blood pressure (BP) at baseline (1996 or 1997) and subsequent follow-up examinations (1997, 1998, and 1999). They were followed up for a maximum of 4 years for possible adverse outcomes (death, placement on “injured-on-duty” status, termination of duty, resignation, retirement, or incident cardiovascular disease). In several analytic models, we found that firefighters with stage II hypertension (BP ≥ 160/100 mm Hg) were consistently 2 to 3 times more likely to experience an adverse outcome compared with those with normal BP. Cox proportional-hazards regression was used to adjust for age, body mass index, smoking, cholesterol, and antihypertensive medication. In these models, the hazard ratio for stage II hypertension was 3.2 (95% confidence interval [CI], 1.50 to 7.04, P = 0.003) and for untreated stage II hypertension, it was 4.6 (95% CI, 2.08 to 10.11, P = 0.0002). Firefighters with a BP ≥ 160/100 mm Hg should receive further evaluation and demonstrate improved BP control before being determined fit for duty.

From the Cambridge Hospital, Cambridge, Massachusetts (Dr Kales, Dr Soteriades, Mr Christoudias, Mr Tucker); the Harvard School of Public Health, Department of Environmental Health (Occupational Health Program), Boston Massachusetts (Dr Kales, Dr Soteriades, Dr Christiani); Boston University School of Medicine, Boston, Massachusetts (Mr Nicolaou); Massachusetts General Hospital, Pulmonary/Critical Care Unit, Harvard Medical School, Boston, Massachusetts (Dr Kales, Dr Christiani); and the Olympus Specialty and Rehabilitation Hospital, Center for Occupational and Environmental Medicine, Braintree, Massachusetts (Dr Christiani).

Address correspondence to: Stefanos N. Kales, MD, MPH, Cambridge Hospital, Department of Medicine, Occupational and Environmental Health, 1493 Cambridge St, Cambridge, MA;

This study was supported by NIOSH OH03729 and ES00002.

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©2002The American College of Occupational and Environmental Medicine