Global study reveals hypertension common among middle-aged couples

By Pooja Toshniwal PahariaReviewed by Sophia CoveneyDec 10 2023

In a recent study published by the Journal of the American Heart Association, researchers comparatively assessed concordant hypertension prevalence in middle‐aged heterosexual couples living in England, the United States (US), India, and China.

Background

Hypertension or elevated blood pressure (BP) is a global public health issue, especially among nations with low or middle-level income. Early detection and treatment can help lower the disease burden. Spousal health concordance, defined as comparable health status between partnered or married couples, offers an opportunity to develop interventions to detect and control hypertension at a couple level.

Interpersonal risk among couples is quantified in studies, which might inform screening, preventive, and treatment approaches. International comparison studies with nationally representative sample populations stratified by gender may increase the accuracy and generalizability of study findings, leading to more effective treatments for hypertension detection and management at the couple level.

About the study

In the present cross-sectional study, researchers analyzed concordant hypertension prevalence among heterosexual partners in population-based studies conducted across England, the US, India, and China. They also examined association strengths, comparing wives to husbands and the differences in the association across nations.

The sample population comprised 3,989 couples from the United States Health and Retirement Study (HRS) 2016-17 aged ≥18 years; 1,086 couples who participated in the English Longitudinal Study on Aging (ELSA) study 2016-17; 6,514 couples (husbands aged ≥22 years and wives aged ≥20 years) from the China Health and Retirement Longitudinal Study (CHARLS) 2015-16; and 22,389 couples (husbands aged ≥21 years and wives aged ≥18 years) in India from the Longitudinal Aging Study in India (LASI) 2017-19.

The researchers analyzed dyadic data on heterosexual couples from the four studies to determine the rates of concordant hypertension, described as both wife and husband having hypertension. The Gateway to the Global Aging Data staff from Southern California University harmonized data.

All four studies obtained data using household surveys by initially enrolling eligible primary participants and then requesting spouse/partner participation. The ELSA and HRS surveyed individuals aged ≥50, whereas the LASI and CHARLS surveyed those aged ≥45 and their partners, irrespective of age.

Participants with hypertension were identified by having systolic BP of 140 mm  Hg or higher, diastolic BP of 90 mm of Hg or higher, or high BP history, and medication prescriptions were only asked of those who self-documented hypertension. The team analyzed individual-level health and sociodemographic characteristics, including age, education, and employment status, as conventional risk factors for hypertension.

Health-associated patient characteristics included excessive alcohol intake, moderate-intensity physical exercise, and body mass index (BMI). Household characteristics, such as wealth, expenditures, number of members, children, marriage length, and residence region, were considered potential confounders. Poisson regression modeling was performed, and prevalence ratios (PRs) were calculated.

Results

The mean participant age ranged between 51 years (India) and 73 years (England) among wives and between 57 years (India) and 74 years (England) among husbands. Across nations, hypertension prevalence among wives was lower than among husbands, with a maximum difference in US couples (55% for wives vs. 65% for husbands). Concordant hypertension prevalence in the US, England, China, and India were 38%, 47%, 21%, and 20%, respectively.

The team observed positive associations of concordant hypertension for husbands and wives in each nation. Compared to wives with non-hypertensive husbands, wives with hypertensive husbands showed an increased likelihood of having hypertension in the US, England, China, and India. Compared to husbands with non-hypertensive wives, husbands with hypertensive wives showed an increased likelihood of being hypertensive in the US, England, China, and India.

The team noted similar associations in England and the US but association differences of higher magnitude in India and China. Similar results were obtained after adjusting for individual, household, and spouse-related characteristics, with no differences in evaluations stratified by wealth quintile, residence, marriage duration, level of education, and age.

Overall, the study findings showed high prevalent rates of hypertension (20% to over 40%) among middle-aged heterosexual partners in England, the US, India, and China. The findings indicate that couple-centered interventions might be effective in preventing and managing hypertension in these nations.