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To test the hypothesis that work stress (persistent high job demands over 1 year) in combination with high reactivity to mental stress predict ambulatory blood pressure.Assessment of cardiovascular responses to standardized behavioural tasks, job demands, and ambulatory blood pressure over a working day and evening after 12 months.We studied 81 school teachers (26 men, 55 women), 36 of whom experienced persistent high job demands over 1 year, while 45 reported lower job demands.Participants were divided on the basis of high and low job demands, and high and low systolic pressure reactions to an uncontrollable stress task. Blood pressure and concurrent physical activity were monitored using ambulatory apparatus from 0900 to 2230 h on a working day.Cardiovascular stress reactivity was associated with waist/hip ratio. Systolic and diastolic pressure during the working day were greater in high job demand participants who were stress reactive than in other groups, after adjustment for age, baseline blood pressure, body mass index and negative affectivity. The difference was not accounted for by variations in physical activity.Cardiovascular stress reactivity and sustained psychosocial stress may act in concert to increase cardiovascular risk in susceptible individuals.