Document Type
Article
Publication Date
8-14-2020
Abstract
Aims
Optimism is associated with reduced cardiovascular disease risk; however, few prospective studies have considered optimism in relation to hypertension risk specifically. We investigated whether optimism was associated with a lower risk of developing hypertension in U.S. service members, who are more likely to develop high blood pressure early in life. We also evaluated race/ethnicity, sex and age as potential effect modifiers of these associations.
Methods
Participants were 103 486 hypertension-free U.S. Army active-duty soldiers (mean age 28.96 years, 61.76% White, 20.04% Black, 11.01% Hispanic, 4.09% Asian, and 3.10% others). We assessed optimism, sociodemographic characteristics, health conditions, health behaviours and depression status at baseline (2009–2010) via self-report and administrative records, and ascertained incident hypertension over follow-up (2010–2014) from electronic health records and health assessments. We used Cox proportional hazards regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), and adjusted models for a broad range of relevant covariates.
Results
Over a mean follow-up of 3.51 years, 15 052 incident hypertension cases occurred. The highest v. lowest optimism levels were associated with a 22% reduced risk of developing hypertension, after adjusting for all covariates including baseline blood pressure (HR = 0.78; 95% CI = 0.74–0.83). The difference in hypertension risk between the highest v. lowest optimism was also maintained when we excluded soldiers with hypertension in the first two years of follow-up and, separately, when we excluded soldiers with prehypertension at baseline. A dose–response relationship was evident with higher optimism associated with a lower relative risk (p < 0.001). Higher optimism was consistently associated with a lower risk of developing hypertension across sex, age and most race/ethnicity categories.
Conclusions
In a diverse cohort of initially healthy male and female service members particularly vulnerable to developing hypertension, higher optimism levels were associated with reduced hypertension risk independently of sociodemographic and health factors, a particularly notable finding given the young and healthy population. Results suggest optimism is a health asset and a potential target for public health interventions.
Recommended Citation
Kubzansky, L. D., Boehm, J. K., Allen, A. R., Vie, L. L., Ho, T. E., Trudel-Fitzgerald, C., Koga, H. K., Scheier, L. M, & Seligman M. E. P. (2020). Optimism and risk of incident hypertension: A target for primordial prevention. Epidemiology and Psychiatric Sciences, 29, e157. https://doi.org/10.1017/S2045796020000621
Copyright
The authors
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
Included in
Cardiovascular Diseases Commons, Health Psychology Commons, Other Psychiatry and Psychology Commons, Other Psychology Commons, Personality and Social Contexts Commons, Psychological Phenomena and Processes Commons
Comments
This article was originally published in Epidemiology and Psychiatric Sciences, volume 29, in 2020. https://doi.org/10.1017/S2045796020000621