The authors performed a meta-analysis of observational studies to estimate the magnitude of spousal concordance for hypertension and to examine whether the concordance varied by important study methodological aspects. PubMed and Embase were searched up to June 2017 for cross-sectional, case-control, and cohort studies that investigated the concordance/association of hypertension between spouse pairs. A meta-analysis with random-effects models was performed by pooling adjusted odds ratios. Eight studies with a total number of 81 928 spouse pairs were eligible. The pooled results showed that spouses of individuals with hypertension had 41% (odds ratio, 1.41; 95% confidence interval, 1.21-1.64) increased odds of having hypertension themselves. The association applied to both men and women, and was not significantly different between studies with adjustment for body mass index and those without. The findings highlighted the importance of environmental factors in the development of hypertension. | INTRODUCTIONHypertension is the leading risk factor for morbidities and mortalities caused by cardiovascular and kidney diseases. The Global Burden Project estimated that hypertension accounts for 9.4 million deaths each year worldwide.1 Hypertension is a complex disorder resulting from both genetic and environmental determinants. and body mass index (BMI), spousal diagnosis of hypertension was the strongest risk factor of hypertension for men and second strongest risk factor for women, with adjusted risk estimates at two-to three-fold. 7 In another community-based population study in Brazil, however, the spousal association was not significant after adjusting for age. 9 Therefore, these inconsistencies and uncertainties need to be addressed using quantitative and comparative methods.Previous meta-analyses have observed a significant positive spousal concordance for diabetes mellitus and the majority of main coronary risk factors. 15,16 However, no meta-analysis has summarized the available evidence of spousal concordance for hypertension. In addition, the mechanism through which spousal concordance operates was not known. The concordance may operate through the Zhancheng Wang and Wenhui Ji contributed equally to this work.

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