Spouses or partners in heterosexual relationships may have high blood pressure that mirrors each other, according to a new multinational study.
If one spouse in a heterosexual couple has high blood pressure, the other often does too, according to new research published in the Journal of the American Heart Association , an open-access, peer-reviewed journal of the American Heart Association. .
"Many people know that high blood pressure is common in middle-aged and older adults, but we were surprised to find that among many older couples, both husband and wife had high blood pressure in the US, England, China and India," said lead author Chihua Li, Dr. PH, a postdoctoral fellow at the University of Michigan and corresponding author of the study. "For example, in the United States, more than 35% of couples aged 50 or older both had high blood pressure."
Researchers studied whether heterosexual couples in the United States, England, China and India reflected each other’s high blood pressure status. Previous studies have explored the linkage of high blood pressure and other diseases among couples in a single country or used small regional samples.
"Ours is the first study to examine the relationship between high blood pressure in couples from high- and middle-income countries," said study co-senior author Jithin Sam Varghese, Ph.D., research assistant professor at Emory Global. Diabetes. Emory University Research Center in Atlanta. "We wanted to find out whether many married couples who often have the same interests, living environment, living habits and health outcomes can also share high blood pressure."
The researchers analyzed the blood pressure measurements of 3,989 American couples, 1,086 English couples, 6,514 Chinese couples, and 22,389 Indian couples and found:
The prevalence of high blood pressure in both spouses or partners was approximately 47% in England; 38% in the United States; 21% in China and 20% in India.
Compared with wives married to husbands without high blood pressure , wives whose husbands had high blood pressure were 9% more likely to have high blood pressure in the United States and England, 19% more likely in India, and 26% more likely to have high blood pressure. % more likely in China.
Associations of hypertension status between couples and sex differences within each country. A, Association of hypertension status between couples (Table S4, Equation 1a and 1b). B, Sex difference in associations comparing husbands and wives (Table S4; Equation 2). All values are survey-weighted prevalence ratios with robust 95% CIs, after adjusting for individual characteristics and household characteristics.
Within each country, similar associations were observed for husbands. The association was consistent when analyzes were stratified by area of residence within each country, household wealth, duration of marriage, age groups, and educational levels.
"High blood pressure is more common in the US and England than in China and India; however, the association between partners’ blood pressure status was stronger in China and India than in the US and England "One reason could be cultural. In China and England and in India, there is a strong belief in staying together as a family, so couples could have more influence on each other’s health," said study co-lead author Peiyi Lu. , Ph.D., postdoctoral fellow in epidemiology at Columbia University Mailman School of Medicine. Public health. "In the collectivist societies of China and India, couples are expected to depend on and support each other, emotionally and instrumentally, so health may be more closely intertwined."
These findings highlight the potential of using couple-based approaches for the diagnosis and treatment of high blood pressure, such as couple-based screening, skills training, or joint participation in programs, Li noted.
Background and details of the study:
The researchers used cross-sectional data (capturing a single point in time) taken from aging studies that are representative of populations in entire countries, including the 2016-17 US Health and Retirement Study, the Longitudinal in English from 2016-17. Aging Study, 2015-16 China Longitudinal Study of Health and Retirement, and 2017-19 India Longitudinal Study of Aging. These four studies have harmonized design and measures, and each adopted a household survey that first recruited a primary participant who met the eligibility age: 50 years or older for studies in the US and England and 45 years or older for studies in China and India. – and then invited your spouse or partner to participate regardless of her age.
Couples were defined as heterosexual participants living in the same household and reporting being married or in a relationship, and those who were over the legal age of marriage in their country at the time of the survey.
The average age of husbands in the study was 65.7 years in the United States; 74.2 years in England; 61.5 in China; and 57.2 years in India. The average age of wives in the study was 62.9 years in the United States; 72.5 years in England; 59.2 years in China and 51.1 years in India.
High blood pressure was defined based on measurements at a given time. Participants were considered to have hypertension if they had one of the following: systolic blood pressure greater than 140 mm Hg or diastolic blood pressure greater than 90 mm Hg, as measured by healthcare professionals; or if they answered yes when asked if they had a history of high blood pressure.
Among the study’s limitations were its cross-sectional design, meaning it captured a single point in time and therefore only one blood pressure measurement, and that the surveys included only heterosexual couples.
According to 2023 statistics from the American Heart Association, in 2020, nearly 120,000 deaths were primarily attributable to high blood pressure, and from 2017 to 2020, 122.4 million (46.7%) American adults had high blood pressure. .
Varghese, Lu, and their colleagues report an important finding among middle-aged and older adults: If your spouse has hypertension, you are more likely to have hypertension, too .
These findings are important because hypertension is among the most dominant modifiable cardiovascular risk factors and remains highly prevalent and poorly controlled at an increasingly global level. As the authors point out, the current approach of clinical and public health strategies to control hypertension at the individual level is not adequate . The authors suggest that interventions targeting spouses may, therefore, be especially effective," said Bethany Barone Gibbs, Ph.D., FAHA, associate professor and chair of the department of epidemiology and biostatistics at the Harvard School of Public Health. West Virginia University and chair of the writing committee for the Association’s 2021 Statement on Physical Activity as a Critical Component of First-Line Treatment for High Blood Pressure or Cholesterol.
"Following this idea, making lifestyle changes, such as being more active, reducing stress, or eating a healthier diet, can lower blood pressure; however, these changes can be difficult to achieve and, more importantly, support if your spouse or partner (and larger family unit) are not making changes with you," he said. "These findings also suggest a broader approach: interventions using a socioecological model that considers the determinants of hypertension at the individual, interpersonal, environmental and political levels are likely to be necessary to reduce the burden of hypertension on global public health. ".
Conclusions In summary, our study found positive concordance of hypertension status in heterosexual couples in four socially and economically diverse countries using data from large population-representative studies. The associations were of similar magnitude for husbands and wives within each country. Spousal concordance for hypertension was slightly stronger in China and India than in the United States or England. Approximately half of all cases of hypertension are concordant within spouses, implying that up to half of middle-aged and older adults with high blood pressure could benefit from a couple-centered strategy to improve the diagnosis and treatment of hypertension. the hypertension. |
Clinical perspective
What’s new?
This cross-sectional study shows a high prevalence of concordant hypertension ranging from 20% to >40% among middle-aged and older heterosexual couples in the United States, England, China, and India.
Positive associations of hypertension status within couples were observed in these four countries, with slightly stronger associations in China and India than in the United States and England.
What are the clinical implications?
The high prevalence of concordant hypertension in heterosexual couples suggests that a large proportion of middle-aged and older adults with hypertension could benefit from couple-centered strategies to improve the diagnosis and treatment of hypertension.
Reference: Jithin Sam Varghese, Peiyi Lu, Daesung Choi, Lindsay C. Kobayashi, Mohammed K. Ali, Shivani A. Patel, Chihua Li. Spousal Concordance of Hypertension Among Middle‐Aged and Older Heterosexual Couples Around the World: Evidence From Studies of Aging in the United States, England, China, and India. Journal of the American Heart Association , 2023; DOI: 10.1161/JAHA.123.030765
