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The case subject is a housewife born December, 1960. She will be 39 years old this year. She works at a food preparation factory from three to seven a.m. five days a week. Her family is a husband, an elementary school age child, and a kindergartner; she worked the night shift during child care. A night health check was performed for the first time five years ago when she was 33; somehow she had had no previous examinations. The examination came three months after she began work and showed 150 mmHg blood pressure and 1 day average of ABPM (Ambulatory Blood Pressure Monitoring) of 151/92 mmHg. Right away I recommended a physical examination emphasizing the circulatory system. After three months, she took a health examination once again. However, she did not begin treatment. Finding 150/100 mmHg, ABPM 1 day average 166/102 mmHg, I instructed that she be removed from the night shift immediately. She joined the night shift once again because her blood pressure improved after she was treated by a local physician. Blood pressure and ABPM average values improved thereafter in health examinations: 1994 - 160/106 159/101, 1996 - 150/90 145/90. Despite this improvement, she continued night work with her continued hypertension. Furthermore, she strongly hoped to change to the midnight to 6:30 shift that was newly introduced from spring, 1997. When health examinations showed 168/110 blood pressure I advised her to consult her physician with this information. The physician had been conducting a Holter ECG without being told ABPM in the case. Although there was frequent pulse, the ischemic blood change was not examined. At this year's routine health examination of September 18, blood pressure was actually 182/120, even the ABPM average was a remarkably high 170/108, and fully 85% of the readings were showing 160/95 or higher values. I spoke in detail on the point of her high blood pressure during the examination, and I questioned whether or not she should continue her irregular shift work. We agreed that she leave work immediately from that day. Consulting with her physician in charge, I took over her treatment for a while to observe her ABPM progress. After two weeks, through increasing one kind of anti-hypertensive agent, her blood pressure dropped modestly to 142/94. When ABPM normalized, I let her go back to the night shift, whereupon I advised her that she could continue to work if ABPM did not increase. From her, I exacted the promise that she would stop working if it did. Owing to anxious observation of her case through several years,at last I am able to accomplish the role of occupational physician with such impressive cases full of bitter experiences. I display these examples of typical ABPM analyses of this factory's employees for reference. 
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