Optimism and risk of incident hypertension: a target for primordial prevention. (14th August 2020)

• Record Type: Journal Article
• Authors: Kubzansky, Laura D.; Boehm, Julia K.; Allen, Andrew R.; Vie, Loryana L.; Ho, Tiffany E.; Trudel-Fitzgerald, Claudia; Koga, Hayami K.; Scheier, Lawrence M.; Seligman, Martin E. P.
• Is Part Of: Epidemiology and psychiatric sciences. Volume 29(2020)
• Publication Date: 2020-08-14
• Subjects: Attitudes, -- epidemiology, -- health outcomes, -- mental health, -- prospective study; Epidemiology -- Periodicals; Mental illness -- Periodicals; Community psychiatry -- Periodicals; 362.2
• DOI: 10.1017/S2045796020000621
• Languages: English
• ISSNs: 2045-7960

Abstract

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.