Arterial Hypertension in Employees of the Penitentiary System: Dynamics of Formation, Prognosis of Course, and Prevention

The dissertation is devoted to the study of arterial hypertension in employees of the penitentiary system — a contingent exposed to long-term professional factors including threats to life, contact with socially significant diseases, physical inactivity, and work in enclosed spaces. The work examines the dynamics of the formation of prehypertension and its transition to arterial hypertension in relation to length of service, position held, and personality psychological features, together with premorbid background factors.

The author conducted a comprehensive analysis of the influence of specific working conditions and individual psychological characteristics on the development of prehypertension during the first years of service, developed a method for predicting its occurrence in persons entering work in the penal system, and proposed a scientifically substantiated prevention model that incorporates targeted selection of positions and early implementation of preventive measures.

Relevance of the Problem

Arterial hypertension (AH) is one of the most pressing problems of modern medicine. Despite certain advances achieved in the diagnosis and treatment of this pathology, a worldwide trend toward an increase in the prevalence of AH among the population has been observed. Mortality among those suffering from AH is 2–3 times higher than among persons without this disease, which indicates not only the medical but also the social significance of the problem of AH [Belenkov Yu.N., 2002; Gogin E.E., 2002; Kobalava Zh.D., 2004; Myers M.G., 2006; Safar M.E., 2006].

Within the framework of the recommendations of the Seventh Joint National Committee on the Treatment of AH (JNC7), the new concept of "prehypertension" (PH) was introduced, corresponding to systolic blood pressure within the range of 130–139 mm Hg and diastolic blood pressure of 80–89 mm Hg [Chobanian A.V., Bakris G.L., Black H.R. et al., 2003]. In the recommendations of the European Society of Cardiology (ESC, 2007) and the All-Russian Scientific Society of Cardiology (VNOK, 2008), the aforementioned condition is considered as "high normal" blood pressure (BP). In our work we use the term PH in order to emphasize the close connection of this condition with the developing primary AH. The expediency of using the term PH in clinical practice has been confirmed in a number of works; in particular, according to data by R.S. Vasan, M.G. Larson, E.P. Leip, et al., 2001, within 4 years every fifth patient with PH will develop AH; in persons with PH compared with optimal BP, the risk of developing coronary heart disease increases 2.3-fold [Kshirsagar A.V. et al., 2003]. Finally, the presence of PH increases the risk of developing myocardial infarction within 10 years by 3.5 times [Qureshi A.I. et al., 2005]. The importance of conducting preventive and therapeutic measures in persons with PH was demonstrated by the TROPHY study (TRial Of Preventing HYpertension): in the absence of antihypertensive therapy, grade I AH developed within 4 years in approximately two-thirds of persons with PH; the use of candesartan, a representative of angiotensin II receptor blockers, in PH led to a reliable reduction in the risk of developing AH [Julius S., Nesbitt S.D., Egan B.M. et al., 2006].

Unfortunately, the etiology of PH and AH at the present stage of the development of medicine has not been fully elucidated. According to the existing concept, AH is a multifactorial disease in the development of which genetic predisposition, unfavorable socio-hygienic and psychological environmental conditions take part. A significant number of studies are devoted to the issue of social and psychological causes of the development of PH and AH. In particular, in some works "occupational hypertension" was identified as one of the variants of stress-induced AH [Kobalava Zh.D., Gudkov K.M., 2002; Plosker G.L., Foster R.H., 2000].

Service in the penitentiary system fully belongs to the unfavorable factors of the development of "occupational hypertension." Work in the penal system (UIS) is associated with a specific, constantly acting set of psychotraumatic factors that may be associated with real or potential damage to regulatory systems, form personality behavioral features, and lead to the development of both PH and AH [Rozhdestvenskaya T.V., Shlyakhto E.V., 2005; Simonenko V.B., 2008; Tsai P.S., 2003; Anand J., 2005].

Among the unfavorable factors of work in the UIS, it is necessary to single out a potential threat to life (or being taken hostage), a high probability of infection with HIV, tuberculosis, or other socially significant diseases, carrying weapons, physical inactivity, working in an enclosed space, etc. However, until now no analysis has been conducted of the influence of unfavorable work factors under the conditions of the penitentiary system on the risk of developing PH and AH in employees. At the same time, the study of the influence of working conditions, somatic, psychological, and characterological features of the personality on the occurrence of PH and its progression in UIS employees is of great importance, since it allows a significant contribution to the prevention of cardiovascular diseases (CVD) in persons of this contingent. The aforementioned unresolved problems of the development and course of PH and AH in young employees of the penitentiary system attest to the relevance and necessity of further research in this field.

Aim of the Study

To analyze the dynamics of the formation of arterial hypertension in employees of the penitentiary system and, based on the results of the study, to propose a system for its prognosis, development, and prevention.

Research Objectives

1. To study the influence of unfavorable medical-social factors and personality psychological features on the risk of developing prehypertension in employees of the penitentiary system during the first year of service.

2. To develop a method for predicting the development of prehypertension in the first year of service in persons entering work in the penal system.

3. To study the frequency of occurrence of prehypertension and arterial hypertension in employees of the penitentiary system with account for length of service and position held.

4. To study the influence of position held and unfavorable factors of official activity in the penal system on the risk of transition of prehypertension to arterial hypertension during the next three years of service.

5. To propose a system of measures aimed at the prevention of prehypertension and arterial hypertension in employees of the penitentiary system.

Scientific Novelty

For the first time, a comprehensive analysis of the influence of specific working conditions, personality psychological features, and unfavorable medical-social factors of the premorbid background on the formation of prehypertension in employees of the penitentiary system has been carried out, and a system for predicting its development and course has been developed.

For the first time, it has been established that in the presence of prehypertension in employees of the penitentiary system, its rapid transformation into arterial hypertension is largely associated with work in positions of the junior commanding staff, potential threat to life (or being taken hostage), contact with patients with socially significant diseases, physical inactivity, and work in an enclosed space.

For the first time, a scientifically substantiated model for the prevention of the development of prehypertension and arterial hypertension in employees of the penitentiary system has been proposed, based on a comprehensive assessment of unfavorable factors of the premorbid background, personality psychological features, and working conditions.

Scientific and Practical Significance

The theoretical and practical significance of the study consists in the further investigation of the mechanisms of development of prehypertension and arterial hypertension, their connections with stress reactions, and in the possibility of including the main provisions of the work in the programs of teaching physiology and cardiology for students and cadets of postgraduate training.

The data obtained extend the accumulated knowledge about the prevalence of prehypertension and arterial hypertension among employees of the penal system and allow analysis of the connection of psychosocial (occupational) stress with the risk of developing arterial hypertension in persons of young age.

The developed system for predicting the development of prehypertension among persons entering work in the penitentiary system makes it possible to timely carry out a set of preventive measures aimed at preventing the development of this pathology during the period of service.

The conducted studies have shown that the main direction of preventive work to prevent the development of prehypertension and arterial hypertension in employees of the penitentiary system should be the identification at the time of hiring of persons with a high risk of developing prehypertension and analysis of the likelihood of its rapid transformation into arterial hypertension in order to carry out timely preventive and therapeutic measures among them and to select working conditions that reduce the risk of developing the disease.

Main Provisions Defended

1. The highest risk of developing prehypertension during the first year of service in the penitentiary system is observed in persons with a high level of anxiety, emotional lability, and hypomania, combined with unfavorable factors of the premorbid background in the form of disturbances of antenatal and perinatal development, a burdened family history of arterial hypertension, tobacco smoking, and signs of alimentary obesity.

2. The maximum risk of transition of prehypertension to arterial hypertension within the next three years of service is observed in employees holding positions of the junior commanding staff in the penitentiary system, combined with such unfavorable working conditions as potential threat to life (or being taken hostage), contact with patients with socially significant diseases, physical inactivity, and work in an enclosed space.

3. The main directions of preventive work to reduce the occurrence of prehypertension and arterial hypertension in employees of the penitentiary system should be the identification at the time of hiring of persons with a high risk of developing prehypertension and the likelihood of its rapid transformation into arterial hypertension, as well as the targeted and timely implementation of preventive and therapeutic measures, and a personalized approach to the selection of positions for this category of persons.

Implementation of Research Results

The results of the study, conclusions, and recommendations of the dissertation are used in the work of the military-medical commission of the GUFSIN of Russia for the Saratov Region; they have been introduced into the practical activity of physicians of the Center for Medical and Social Rehabilitation of the GUFSIN of Russia for the Saratov Region.

Approbation of the Work

The main materials of the dissertation research were reported at the Russian Scientific and Educational Forum "Cardiology — 2005" (Moscow, 2005) and "Cardiology — 2007" (Moscow, 2007); at the I National Congress of Therapists (Moscow, 2006); the II Congress of Cardiologists of the Volga Federal District (Saratov, 2008); and the Interdepartmental Scientific and Practical Conference "Arterial Hypertension in Employees of the Penitentiary System" (Saratov, 2009).

Scope and Structure of the Dissertation

The dissertation is presented on 147 pages of typewritten text and consists of an introduction, a literature review, a description of materials and methods, 3 chapters of original research, a conclusion, findings, and practical recommendations.

The work is illustrated with 13 tables and 13 figures. The bibliography contains 347 sources (144 domestic and 203 foreign).