Hypertension Incidence Is Predicted by High Levels of Hopelessness in Finnish Men

Abstract

Abstract-Recent studies have reported that hopelessness is an important factor in cardiovascular morbidity and mortality, including ischemic heart disease, acute myocardial infarction, and atherosclerotic progression. This study examined the relationship between hopelessness and incident hypertension in a population-based sample of 616 initially normotensive, middle-aged men from eastern Finland, an area with high rates of cardiovascular disease. Participants completed a medical examination and a series of psychological questionnaires at baseline and at the 4-year follow-up. Hopelessness was measured by 2 items assessing negative expectancy about the future and one's goals. A logistic regression model with adjustments for age, body mass index, baseline resting blood pressure, physical activity, smoking, alcohol consumption, education, parental history of hypertension, and self-reported depressive symptoms revealed that men reporting high levels of hopelessness at baseline were 3 times more likely to become hypertensive (systolic blood pressure Ն165 mm Hg and/or a diastolic blood pressure Ն95 mm Hg or confirmed use of antihypertensive medication) in the intervening 4 years than men who were not hopeless (odds ratio, 3.22; 95% confidence interval, 1.56, 6.67). Men reporting moderate levels of hopelessness were not at a significantly increased risk of hypertension (odds ratio, 1.27; 95% confidence interval, 0.79, 2.07). This is the first study to identify a significant relationship between hopelessness and incident hypertension. Research is needed to explore the neuroendocrine and central nervous system mechanisms underlying this association. Key Words: cardiovascular diseases Ⅲ depression Ⅲ hopelessness Ⅲ men Ⅲ psychology Ⅲ risk factors S everal risk factors for hypertension that have important lifestyle and psychosocial components have been identified, including obesity, 1 excess sodium consumption, 2 excess alcohol consumption, 3 and physical inactivity. 4,5 All are associated with an increased risk of hypertension. Research also suggests that psychosocial stress and concomitant sympathetic nervous system reactivity may play a role in hypertension and increases in blood pressure (BP) over time, 6 -8 as may certain emotions, including anger, anxiety, and depression. 9 -11 Previously, we reported that hopelessness, characterized as a sense of futility and negative expectations about the future and one's personal goals, predicts incident myocardial infarction and cardiovascular mortality 12 and is associated with a faster progression of carotid atherosclerosis 13 in middle-aged men. In both cases, the effects of hopelessness on cardiovascular disease morbidity and mortality were unchanged after controlling for depressive symptoms in general. Data from the National Health Examination Follow-up Survey also demonstrated that hopelessness was related to incident fatal and nonfatal ischemic heart disease in men and women during 12 years of follow-up and that the effect of hopelessness was stronger than the effect of d...

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