It is well known that blood pressure increases when one perceives challenging demands or is exposed to unexpected strains.1 In the long run, this acute effect might lead to elevated blood pressure that is, hypertension,2 which is the focus of the review by Babu et al.3 The team undertook meta-analyses of nine epidemiological studies which used hypertension as a dependent variable and job strain as independent. Only nine studies were eligible, but cohort and case control studies showed modest significant relationships. It is worth noting that all studies with good methodological quality were positive, while others showed different results. As stated by the authors, earlier reviews have questioned the notion that psychosocial strain leads to hypertension. However, this field of research is precarious as exposure and outcome are difficult to assess.

First, how should the relevant exposure be measured? As the underlying mechanism for a relationship between strain and hypertension is expected to be stress (ie, physiological stress reactions including activation of the sympathetic nervous system), measures …