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Association of Elevated Blood Pressure With Low Distress and Good Quality of Life: Results From the Nationwide Representative German Health Interview and Examination Survey for Children and Adolescents

Berendes, Angela MD; Meyer, Thomas MD, PhD; Hulpke-Wette, Martin MD; Herrmann-Lingen, Christoph MD

doi: 10.1097/PSY.0b013e31828ef0c2
Original Articles

Objective: Quality of life is often impaired in patients with known hypertension, but it is less or not at all reduced in people unaware of their elevated blood pressure. Some studies have even shown less self-rated distress in adults with elevated blood pressure. In this substudy of the nationwide German Health Interview and Examination Survey for Children and Adolescents (KIGGS), we addressed the question whether, also in adolescents, hypertensive blood pressure is linked to levels of distress and quality of life.

Methods: Study participants aged 11 to 17 years (N = 7688) received standardized measurements of blood pressure, quality of life (using the Children’s Quality of Life Questionnaire), and distress (Strengths and Difficulties Questionnaire).

Results: Elevated blood pressure was twice as frequent as expected, with 10.7% (n = 825) above published age-, sex- and height-adjusted 95th percentiles. Hypertensive participants were more likely to be obese and to report on adverse health behaviors, but they showed better academic success than did normotensive participants. Elevated blood pressure was significantly and positively associated with higher self- and parent-rated quality of life (for both, p ≤ .006), less hyperactivity (for both, p < .005), and lower parent-rated emotional (p < .001), conduct (p = .021), and overall problems (p = .001). Multiple regression analyses confirmed these findings.

Conclusions: Our observation linking elevated blood pressure to better well-being and low distress can partly be explained by the absence of confounding physical comorbidity and the unawareness of being hypertensive. It also corresponds to earlier research suggesting a bidirectional relationship with repressed emotions leading to elevated blood pressure and, furthermore, elevated blood pressure serving as a potential stress buffer.

From the Department of Psychosomatic Medicine and Psychotherapy (A.B., T.M., C.H.-L.), University of Göttingen, Germany, and Private Pediatric Practice (M.H.-W.), Göttingen, Germany.

Address correspondence and reprint requests to Christoph Herrmann-Lingen, MD, Department of Psychosomatic Medicine and Psychotherapy, German Centre for Cardiovascular Research, University of Göttingen Medical Centre, von-Siebold-Str. 5, D-37075 Göttingen, Germany. E-mail:

Received for publication August 17, 2012; revision received December 18, 2012.

Copyright © 2013 by American Psychosomatic Society
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