New Study Shows Link Between Hopelessness And Hypertension

The study of 616 middle-aged men from eastern Finland showed that men, who suffered from feelings of high hopelessness over the course of the four-year study, were three times more likely to develop hypertension than men who did not suffer from feelings of hopelessness as much, or if at all.

"This is the first study to show that hopelessness is associated with an increased risk of developing hypertension. This is independent of any known risk factors for hypertension. It is further evidence that hopelessness really does affect cardiovascular function. The task now is to identify the hormonal or physiological factors that link hopelessness to hypertension as well as other cardiovascular problems," said Susan A. Everson, assistant research scientist in the U-M School of Public Health's Department of Epidemiology. Everson is senior author of the study that appears in the new issue of Hypertension. The study is co-authored by George A. Kaplan, professor of public health and chair of the Department of Epidemiology at the U-M.

Hopelessness is defined as having a sense of futility and negative expectations about the future and one's personal goals. It is also one of several determinants of depression.

In the study, hypertension was defined as a blood pressure greater than or equal to 165 mm Hg systolic pressure or greater than or equal to 95 mm Hg diastolic pressure, which compares to the recommended 120/80 for adults. Hypertension can increase the risk of having a heart attack and dying from cardiovascular diseases.

After four years, 126 of the 616 men in the study, or 20 percent became hypertensive.

At the beginning of the four-year study, 8 percent of the 616 men were considered "high in hopelessness," 32 percent reported moderate levels of hopelessness and 60 percent suffered from very little or no feelings of hopelessness.

After four years, 37 percent of the 616 men considered "high in hopelessness" developed hypertension; 23 percent of moderates developed hypertension and 17 percent of those who experienced little or no hopelessness developed hypertension.

"Our data support the idea that hopelessness is more strongly related to adverse cardiovascular consequences than is depression; however, additional work is needed to test this hypothesis and to determine if hopelessness is the critical feature of depression that confers increased cardiovascular risk. Work also is needed to address the determinants of and ways to alleviate hopelessness for the benefit of the public's health," the authors write.

The study is based on data from the Kuopio Ischemic Heart Disease Risk Factor Study (KIHD), a population-based study of biological, psychosocial and socioeconomic risk factors for cardiovascular disease and related problems in middle-aged men from the Kuopio region in eastern Finland.

The results of the U-M study were adjusted for age, body mass index, baseline resting blood pressure, physical activity, smoking, alcohol consumption, education, parental history of hypertension and self-reported depressive symptoms.

Much research and medical attention has been given to the physical risk factors of developing heart disease, but little attention is paid to emotional risk factors, the researchers said. 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.

Everson's body of research focuses on the impact of negative emotions, such as hopelessness, depression and anger on heart disease, hypertension and stroke. Her past research has shown that high levels of anger, expressed outwardly in an aggressive way, are related to increased risk of developing hypertension and increased risk of stroke.

"My research on hopelessness and anger has provided clear and important epidemiological evidence of the significant impact that emotions or psychological states can have on physical health. The next important step to take in this line of research is to understand the mechanisms that link emotions to cardiovascular disease risk," Everson said.

Everson and colleagues are currently examining hormonal or biochemical factors that may link hopelessness and depression to cardiovascular disease. They are focussing on abnormalities in serotonin and cortisol in relation to hopelessness, depression, and cardiovascular disease. "My goal is for such research to shed light on treatment as well as prevention strategies for heart disease, hopelessness and depression," Everson said.

Everson and Kaplan's new study was funded by the National Heart Lung and Blood Institute, National Institute of Aging, the Academy of Finland and the Finnish Ministry of Education.