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Taking the tension out of hypertension: a prospective study of psychological well being and hypertension

Trudel-Fitzgerald, Claudiaa; Boehm, Julia K.b; Kivimaki, Mikac; Kubzansky, Laura D.d

doi: 10.1097/HJH.0000000000000175

Background: Previous studies have shown that psychological well being is associated with reduced risk of cardiovascular disease. However, whether well being might be specifically associated with reduced risk of hypertension has not been rigorously investigated in prospective studies.

Objective: This study examined the prospective association between two measures of psychological well being and incident hypertension.

Methods: Participants were 6384 healthy British civil servants aged 39–63 from the Whitehall II cohort. Psychological well being (emotional vitality and optimism) and cardiovascular risk factors (demographic characteristics, health status, health behaviors, psychological ill being) were assessed during the 1991–1994 baseline. Incident hypertension was defined by clinical measures of SBP or DBP at least 140/90 mmHg, self-reported physician-diagnosed hypertension, or treatment for hypertension. Follow-up assessments of hypertension took place approximately every 3 years through 2002–2004. Cox proportional hazards regression models estimated hazard ratios.

Results: There were 2304 cases of incident hypertension during the follow-up period. High versus low emotional vitality was associated with a significantly reduced risk of hypertension in an age-adjusted model (hazard ratio = 0.89; 95% confidence interval 0.80–0.98). This association was maintained after controlling for demographic characteristics and health status, but was slightly attenuated after adjusting for health behaviors and ill being. Optimism was not significantly associated with hypertension.

Conclusion: High emotional vitality was associated with reduced hypertension risk; favorable health behaviors explained only part of the relationship. Associations did not differ by age, were similar for men and women, and were maintained after accounting for ill being.

aSchool of Psychology, Laval University, Quebec City, Québec, Canada

bDepartment of Psychology, Chapman University, Orange, California, USA

cDepartment of Epidemiology and Public Health, University College London, London, UK

dDepartment of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, USA

Correspondence to Dr Laura D. Kubzansky, PhD, MPH, Department of Social and Behavioral Sciences, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA. Tel: +1 617 432 3589; fax: +1 617 432 3123; e-mail:

Abbreviations: CI, confidence interval; CVD, cardiovascular disease; SD, standard deviation

Received 31 July, 2013

Revised 9 December, 2013

Accepted 14 February, 2014

Part of the work has been presented in posters at the 71st Annual Scientific Meeting of the American Psychosomatic Society, Miami, USA (March 2013), and at the 13th Annual Meeting of La Société québécoise de lipidologie, de nutrition et de métabolisme, Québec, Canada (May 2012).

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