Researchers revealed the prevalence rate of both partners having high BP: 47% in England, 38% in the US, 21% in China, and 20% in India.
High blood pressure.
If one partner in a heterosexual relationship has high blood pressure, can the other partner also develop the condition? You would think not, since hypertension is a non-communicable disease, however, you would also be — to a certain percentage — incorrect.
A study in the Journal of the American Heart Association found that in India, wives are about 19 percent more likely to develop high blood pressure if their husbands have the condition.
The researchers of the study explored whether heterosexual partners in India, the United States, England, and China exhibit a correlation in their high blood pressure status. “Ours is the first study examining the union of high blood pressure within couples from both high- and middle-income countries,” said study co-lead author Dr Jithin Sam Varghese in a statement.
“We wanted to find out if many married couples, who often have the same interests, living environment, lifestyle habits, and health outcomes, also share high blood pressure,” said Dr Varghese.
“Many people know that high blood pressure is common in middle-aged and older adults, yet 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 senior author Chihua Li in a statement.
“For instance, in the US, in more than 35 percent of couples who were 50 years or older, both had high blood pressure,” Li noted.
The researchers analysed blood pressure data from 3,989 couples in the United States, 1,086 couples in England, 6,514 couples in China, and 22,389 couples in India.
Their findings revealed the following prevalence rate of both partners having high blood pressure: Approximately 47 percent in England, 38 percent in the US, 21 percent in China, and 20 percent in India.
“One explanation is that couples’ health behaviours become similar over time. According to the social control theory, while wives may be more vulnerable to their husbands’ health condition due to the traditional caretaker role, they may also actively attempt to change their husbands’ health behaviours. As such, the couples’ health influence on each other may converge over time. This theory is especially germane for these findings, considering the couples studied here had been married for a mean of 30 years and over,” the study stated.
Compared to wives married to husbands without high blood pressure, wives whose husbands had high blood pressure showed increased likelihoods of having high blood pressure themselves: by 9 percent in the US and England, 19 percent in India, and 26 percent in China.
“In Asian cultural contexts, collectivism is enshrined and family members, including spouses, are encouraged to depend on each other, producing a stronger interpersonal relationship. In contrast, individualism emphasised by Western cultures promotes mutual independence and freedom. As such, couples in India and China may exhibit a stronger spousal concordance than those in the United States and England. Additionally, there might be genetic, environmental, or gene–environment interactions that may also explain the differences in the magnitude of association,” said the study.
“High blood pressure is more common in the US and England than in China and India, however, the association between couples’ blood pressure status was stronger in China and India than in the US and England,” said the study co-lead author Dr Peiyi Lu in a statement.
Speaking to South First, Consultant Interventional Cardiologist at Yashoda Hospitals in Hyderabad, Dr Ravi Kanth, says, “By now, one might expect there to be research papers exploring whether a spouse can be held responsible for causing hypertension in their partner. However, in my experience with numerous couples, particularly elderly ones, I’ve observed instances where one partner may display aggressive behaviour or stress, while the other maintains normal blood pressure levels.”
He adds that, in reality, it’s not convincing to attribute one partner’s behaviour as the direct cause of the other partner’s hypertension.
“There may be some commonalities in lifestyle, such as shared dietary habits — possibly consuming excessive salt — or a lack of physical activity due to their merged lifestyle. These factors might indirectly contribute to blood pressure issues as both partners adopt similar behaviours and dietary patterns,” says Dr Kanth.
He adds that, nevertheless, there isn’t substantial evidence or convincing literature supporting the idea. “In my experience and even in the current literature on hypertension, this particular notion isn’t a prevalent or widely accepted explanation for the development of high blood pressure in individuals within a relationship,” says Dr Kanth.
In the study, the researchers utilised cross-sectional data from comprehensive aging studies representing entire populations in various countries. These included the 2016-17 Health and Retirement Study in the US, the 2016-17 English Longitudinal Study on Aging, the 2015-16 China Health and Retirement Longitudinal Study, and the 2017-19 Longitudinal Aging Study in India.
These four studies shared standardised designs and measurements. Each study employed a household survey that initially recruited primary participants aged 50 years and older for the US and England, and 45 years and older for China and India. Subsequently, the spouse or partner of the primary participant was invited to participate regardless of their age.
The criteria for defining couples were heterosexual individuals living together in the same household, reported as married or partnered, and older than the legal age for marriage in their respective countries at the time of the survey.
The average age of husbands across the study was as follows: 65.7 years in the US, 74.2 years in England, 61.5 years in China, and 57.2 years in India. Meanwhile, the average age of wives in the study was: 62.9 years in the US, 72.5 years in England, 59.2 years in China, and 51.1 years in India.
High blood pressure was determined based on measurements taken at a single time point. Participants were classified as having hypertension if they exhibited either systolic blood pressure higher than 140 mmHg, diastolic pressure greater than 90 mmHg (as measured by healthcare professionals), or if they self-reported a history of high blood pressure.
According to Dr Ravi Kanth, blood pressure, contrary to popular belief, is not typically linked to anger or behavioural patterns in the majority of cases.
“When blood pressure rises due to anger or aggressive behaviour, it does so temporarily and transiently. Having high blood pressure doesn’t necessarily mean a person will be constantly angry. Similarly, experiencing low blood pressure doesn’t signify abnormal behaviour,” says Dr Kanth.
So, what causes the development of high blood pressure? Blood pressure concerns stem from a long-term process that can take decades to evolve within the arteries, which act as the body’s vasculature.
For example, arteries can be likened to pipes or tubes that carry water under pressure. Similarly, the pressure exerted by blood flow against the artery walls is what defines blood pressure — a systemic force that circulates from the heart throughout the body.
“Organs within the body are designed to function under specific blood pressure conditions. When blood pressure elevates, these organs initially attempt to adapt. Organs such as the eyes, kidneys, heart, brain, and liver strive to accommodate high blood pressure. For instance, the heart compensates by bolstering its muscle strength and bulk, while the kidneys respond by increasing the number of glomeruli to counter the high pressure,” says Dr Kanth.
However, these adaptive mechanisms eventually falter. Over time, the heart and kidneys struggle to sustain the high blood pressure. The heart may enlarge and fail, while the kidneys can start leaking protein and function abnormally, leading to kidney failure.
“This silent progression persists for years, earning blood pressure the moniker of a ‘silent killer’. Most individuals, around 95 percent, exhibit no overt symptoms of hypertension until significant organ damage has occurred. Often, individuals become aware of their high blood pressure incidentally when visiting a doctor for unrelated issues such as fever, cough, or breathlessness,” says Dr Kanth.
It’s critical to understand that blood pressure typically manifests without any noticeable symptoms, making it imperative to monitor and manage blood pressure regularly to prevent potential organ damage.
While the associations observed in this study were small in magnitude, they can still have important public health implications at a population level. As population aging is accelerating around the globe, hypertension among older adults is an increasingly important public health concern.
“As such, despite the small associations, considering the growing prevalence of hypertension among older adults in these countries, the potential number of people showing spousal concordance in hypertension would likely be very large,” said the study.
These findings are important because hypertension is among the most dominant modifiable cardiovascular risk factors and remains highly prevalent and poorly controlled on an increasingly global level.
For couples, Dr Kanth suggests fostering positive interdependence between partners, especially in adopting healthy lifestyle choices.
“When one partner engages in beneficial activities like regular physical exercise such as gym workouts, yoga, swimming, or moderate-intensity exercises, the other partner often follows suit. This mutual encouragement extends to being mindful of weight management and maintaining a healthy diet consisting of fresh fruits, vegetables, and reduced salt intake,” suggests Dr Kanth.
This shared commitment to a healthy lifestyle significantly contributes to preventing hypertension or effectively managing it if it already exists. In essence, both partners influence each other positively, creating an environment conducive to better health.
“However, when it comes to attributing one partner’s behaviour as solely responsible for causing hypertension in the other, I firmly believe that such claims would require substantial supporting evidence from numerous research papers. As of now, there seems to be a lack of substantial empirical support for the idea that a partner’s behaviour directly leads to hypertension in their spouse. Hence, further extensive studies and evidence would be needed to validate such claims,” says Dr Kanth.
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