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Blood pressure and fitness for work
1Department of Medicine, University of Chicago, IL 60637.
Insights
Physicians in occupational medicine often exclude job applicants with hypertension, using arbitrary blood pressure cut-offs. This practice highlights a need for standardized guidelines to prevent unfair discrimination against hypertensive individuals seeking employment.
Area of Science:
- Occupational Medicine
- Cardiovascular Health
- Employment Law
Background:
- Hypertension is a prevalent condition affecting workforce participation.
- Current employment practices regarding hypertension lack standardized guidelines.
- Physicians in occupational medicine play a key role in pre-employment screenings.
Purpose of the Study:
- To investigate the prevalence of excluding job applicants due to hypertension.
- To identify the blood pressure thresholds used by occupational physicians for exclusion.
- To assess the variability and arbitrariness in these exclusion criteria.
Main Methods:
- A survey was distributed to 116 members of the American Occupational Medical Association, Central States.
- Respondents reported on company policies and personal initiatives for excluding hypertensive applicants.
- Data on critical diastolic blood pressure values and the severity of hypertension considered were collected.
Main Results:
- 28% of physicians reported excluding hypertensives based on company policy.
- 68% of physicians excluded hypertensives on their own initiative, even without company policy.
- Exclusionary diastolic pressure cut-offs ranged widely (90 to >130 mm Hg), with 19% excluding individuals with mild hypertension.
Conclusions:
- Blood pressure is a common criterion in employment decisions for job applicants.
- The thresholds for precluding work due to hypertension are inconsistent and subjective.
- There is a critical need for evidence-based guidelines to ensure fair employment practices and prevent discrimination against individuals with hypertension.
Abstract:
A survey was carried out to determine whether physicians in Occupational Medicine exclude job applicants because of hypertension and to examine the critical blood pressure cut-off values they apply. The survey sampled 116 respondents, members of the American Occupational Medical Association, Central States. Of these, 33 (28%) reported excluding hypertensives from work permanently, as the policy of one or more of the companies they serve. Another 78 physicians (68%) reported excluding hypertensives permanently on their own initiative when there was no company policy. The critical determining diastolic pressure varied from 90 to greater than 130 mm Hg; 22 respondents (19%) excluded individuals with mild hypertension. The results demonstrate that blood pressure is frequently used as a criterion for employment. Additionally, the level of blood pressure precluding work is arbitrary and variable. There is a need for consensus on appropriate guidelines to preclude inappropriate discrimination against hypertensive job applicants.