**2. Risk factors for hypertension**

#### **2.1 Non-modifiable**

#### *2.1.1 Age*

The prevalence of hypertension is reported to increase with age linearly [20–22].

#### *2.1.2 Genetic*

Positive family history is commonly found in hypertensive patients, with the heritability varying between 35% and 50% in most studies [17, 23]. Family history of hypertension doubles the risk of developing hypertension [24] independent of other risk factors, such as weight, age, and smoking status.

#### *2.1.3 Gender*

Gender is also a critical social determinant of Health to which global forums have increasingly drawn attention. Gender encompasses various practices, beliefs, roles, opportunities, and constraints, shaping men's and women's Health differently. In both men and women, the subjective experience of psychophysiological wellbeing significantly correlates with cardiovascular risk factors [25]. It seems that men must defend their status more often than women. The effects of job strain on BP tend to be stronger among men than women [26].

#### **2.2 Modifiable**

#### *2.2.1 Behavioural*

Excess alcohol consumption and smoking, higher BMI values, and increased total energy intake [19] are recognized as critical behavioural risk factors for HT.

#### *2.2.2 Deprivation and socioeconomic status*

Epidemiologic studies consistently demonstrate graded associations between SES and risk of hypertension, cardiovascular disease, and mortality [27–29]. Low SES is associated with hypertension-related BP patterns, including reduced nocturnal BP dipping [24] and delayed BP recovery following laboratory stress [30].

#### *2.2.3 Type of job*

Employed men are healthier than their unemployed counterparts even after adjusting for low income and low educational attainment [31]. The same holds for women [32], although employment does not affect all women in the same way [33].

#### *2.2.4 Job strain*

Psychosocial stress was defined under four domains: social, work, financial, and environment. Women and young adults reported higher psychological stress levels,

#### **Figure 1.** *Karasek job strain model.*

particularly at work, which raised age-and sex-related job strain issues with high demand and low control (**Figure 1**) [34, 35].

Modifying effect of suppressed anger on the relationship between job stress and hypertension were studied by Cottington et al. [36], and they found that high blood pressure was markedly associated with self-reporting of ambiguous job future, disappointment with colleagues, and advancements in ranks among employees who suppress their anger. These findings advocate that anger expression, a coping mechanism, maybe an important factor that can modify the relation between occupational stress and essential hypertension.
