Optimism and risk of incident hypertension: a target for primordial prevention

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.

Optimism, lifestyle, and longevity in a racially diverse cohort of women

“…Nonetheless, the proportion mediated was modest in magnitude, implying other possible pathways likely also mediate the association of optimism to lifespan. Other possible pathways include neurobiological processes 31,32 and psychosocial resources that promote health or buffer the harmful health impact of stressful experiences 33,34 . For example, studies have investigated how psychological stress and distress can trigger a host of physiological changes (including autonomic nervous system activation, immune system activation, neuroendocrine changes, platelet hypercoagulability, and oxidative stress) and positive psychological factors may buffer psychological stress as well as the physiologic reactions to this sense of stress 33,35 .…”

Positive psychological well‐being and cardiovascular disease: Exploring mechanistic and developmental pathways

“…Findings held when accounting for sociodemographic factors and health, but a single‐item measure of optimism was not associated with incident hypertension in the same cohort. Other research with a large cohort of US army members did find that baseline levels of optimism were associated with reduced risk of hypertension across an average of 3.5 years of follow‐up (Kubzansky, Boehm, Allen, et al., 2020 ).…”

Diversity in U.S. Military Families: An Environmental Scan of the Peer-Reviewed Literature on Race and Ethnic Variation for Select Well-Being Outcomes

“…Outcome Findings Other • Black service members were more likely to be optimistic than were white (but not Asian) service members. This might translate into lower risk of hypertension (Kubzansky et al, 2020). • Black enlisted men were more likely to marry earlier than similar Black civilians (Karney, Loughran, and Pollard, 2012).…”