High Prevalence of Husband, Wife Duos with Hypertension Observed Globally in New Study

A new study of middle-aged and older heterosexual couples residing in the US, England, China, and India showed a high prevalence of concordant hypertension (HTN) ranging from approximately 20% to 47%.¹

Findings were published December 6, 2023, in the Journal of the American Heart Association.

“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 U.S., England, China and India,” said senior author Chihua Li, DrPH, MPH, post-doctoral fellow, University of Michigan, in an American Heart Association (AHA) press release. “For instance, in the U.S., among more than 35% of couples who were ages 50 or older, both had high blood pressure.”²

According to Li and colleagues, spousal concordance of health—defined as similar health status within spouses or partners—offers a unique opportunity to “design interventions for hypertension identification and management at the couple level.”¹

Previous studies have examined spousal concordance of HTN in a single country setting or used small regional samples.¹

“Ours is the first study examining the union of high blood pressure within couples from both high- and middle-income countries,” said colead author Jithin Sam Varghese, PhD, assistant research professor, Emory Global Diabetes Research Center, Emory University, Atlanta, Georgia, in the AHA statement. “We wanted to find out if many married couples who often have the same interests, living environment, lifestyle habits and health outcomes may also share high blood pressure.”²

Investigators used cross-sectional data from the following large, population-representative studies of aging¹:

• 2016/2017 Health and Retirement Study in the US (HRS; n=3989 couples)
• 2016/2017 English Longitudinal Study on Aging (ELSA; n=1086)
• 2015/2016 China Health and Retirement Longitudinal Study (CHARLS; n=6514)
• 2017/2019 Longitudinal Aging Study in India (LASI; n=22 389)

All 4 studies have harmonized design and measures, and each utilized a household survey design to first recruit a primary participant meeting age eligibility and then inviting their spouse or partner to participate, if available. The HRS and ELSA surveyed individuals aged ≥50 years and the CHARLS and LASI surveyed persons aged ≥45 years, according to the study.¹

For the purpose of the study, concordant HTN was defined as both husband and wife in a couple having HTN. Among the cohort, the mean age ranged from 51.1 years (India) to 72.5 years (England) among the wives and 57.2 years (India) to 74.2 years (England) among the husbands.¹

“Participants were considered as having hypertension if they had 1 of the following indicators: systolic blood pressure ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg, or a history of high blood pressure,” noted researchers.¹

FINDINGS¹

Results showed that across the 4 countries, the prevalence of HTN among wives was lower than that among husbands, with the largest difference observed within US couples (54.5% for wives vs 64.5% for husbands).

The prevalence of concordant HTN was 37.9% (95% CI, 35.8–40) in the US, 47.1% (95% CI, 43.2–50.9) in England, 20.8% (95% CI, 19.6–21.9) in China, and 19.8% (95% CI, 19.0–20.5) in India, according to investigators.

“The observed spousal concordance remained consistent when we stratified analyses across various socioeconomic subgroups (eg, residence, education, wealth),” wrote Li and colleagues.

Also, compared with women married to men who did not have HTN, women married to men with HTN were more likely to have HTN in the US (prevalence ratio [PR] 1.09, 95% CI 1.01-1.17), England (PR 1.09, 95% CI 0.98–1.21), China (PR 1.26, 95% CI 1.17–1.35), and India (PR 1.19, 95% CI 1.15–1.24).

“Our findings highlight the potential utility of couple-based interventions for hypertension diagnosis and management, such as couple-based screening, skills training, or joint participation in programs,” wrote investigators.

References:

Varghese JS, Lu P, Choi D, et al. 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.J Am Heart Assoc. Published online December 6, 2023. doi:10.1161/JAHA.123.030765

New study finds many couples around the world may share high blood pressure. News release. American Heart Association. Published December 6, 2023. Accessed December 7, 2023. https://newsroom.heart.org/news/new-study-finds-many-couples-around-the-world-may-share-high-blood-pressure