Current Hypertension Reports

, 20:102 | Cite as

The Relationship Between Psychosocial Status and Hypertensive Condition

  • Ștefania MateiEmail author
  • Stephen J. Cutler
  • Marian Preda
  • Maria Dorobanțu
  • Corina Ilinca
  • Oana Gheorghe-Fronea
  • Luminița Rădulescu
  • Nicoleta Oprescu
  • Alexandru Deaconu
  • Corina Zorilă
  • Bogdan Dorobanțu
Guidelines/Clinical Trials/Meta-Analysis (JB Kostis and W Kostis, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Guidelines/Clinical Trials/Meta-Analysis


Purpose of Review

The aim of the paper is to test the influence of social status and psychological well-being (independent variables) on hypertensive condition (dependent variable), when adjusting for traditional risk factors of cardiovascular disease (control variables). The analysis is based on data collected from SEPHAR III, a nationally representative epidemiologic study of the Romanian adult population.

Recent Findings

Understanding the social roots of health issues is of considerable importance in developing effective strategies and policies. In this context, most studies explain the influence of social and psychological indicators on hypertension by considering the mediating effects of class-based lifestyle practices, i.e., the full range of economic, social, or symbolic resources available to particular social classes. However, the effect of traditional risk factors of cardiovascular disease in shaping the relationship between psychosocial status and hypertension has remained mostly unexplored.


The influence of socioeconomic status and psychological well-being on hypertensive condition is assimilated by age as a variable with both biological and social foundations. Age appears not only as a risk factor for high blood pressure but also as an emergent component of psychosocial status. Furthermore, people without higher education are more likely to be known hypertensives with uncontrolled blood pressure values. Social and economic vulnerabilities (e.g., age, education) are interrelated with several health conditions, which support the necessity to develop and implement integrated public policies based on interventions coordinated across several domains. Moreover, social and psychological determinants that predispose to certain health risks should be considered in medical practice.


Hypertension Socioeconomic status Public policy Integrated approaches 


Compliance with Ethical Standards

Conflict of Interest

The authors declare no conflict of interest relevant to this manuscript.

Human and Animal Rights and Informed Consent

The SEPHAR III survey study was approved by the Romanian Academy of Medical Sciences, National Bioethics Committee for Medicine and Medical Devices (ref: 23SNI) and informed consent was obtained from all the subjects prior to participation in the study.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Rigaud A-S, Forette B. Hypertension in older adults. J Gerontol. 2001;56(4):M217–25.CrossRefGoogle Scholar
  2. 2.
    •• Leng I, Jin Y, Li G, Chen L, Jin N. Socioeconomic status and hypertension: a meta-analysis. J Hypertens. 2015;33:221–9. This paper is a systematic review of observational studies that explored the relationship between hypertension prevalence and socioeconomic status. An increased risk of hypertension was found among people of lower socioeconomic status. The socioeconomic status was measured by using three indicators: income, ocupation, and education. PubMedCrossRefGoogle Scholar
  3. 3.
    Cho KH, Lee SG, Nam CM, Lee EJ, Jang S-Y, Lee S-H, et al. Disparities in socioeconomic status and neighborhood characteristics affect all cause mortality in patients with newly diagnosed hypertension in Korea: a nationwide cohort study, 2002–2013. Int J Equity Health. 2016;15(3):1–9.Google Scholar
  4. 4.
    Satoh A, Arima H, Ohkubo T, Nishi N, Okuda N, Ae R, et al. Associations of socioeconomic status with prevalence, awareness, treatment, and control of hypertension in a general Japanese population: NIPPON DATA2010. J Hypertens. 2017;35:401–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Grotto I, Huerta M, Sharabi Y. Hypertension and socioeconomic status. Curr Opin Cardiol. 2008;23:335–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Almas A, Patel J, Ghori U, Ali A, Edhi AI, Khan MA. Depression is linked to uncontrolled hypertension: a case–control study from Karachi, Pakistan. J Ment Health. 2014;23(6):292–6.PubMedCrossRefGoogle Scholar
  7. 7.
    Ho A, Thorpe C, Pandhi N, Palta M, Smith M, Johnson H. Association of anxiety and depression with hypertension control: a US multidisciplinary group practice observational study. J Hypertens. 2015;33:2215–22.PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Kondo T, Toyoshima H, Tsuzuki Y, Hori Y, Yatsuya H, Tamakoshi K, et al. Familial aggregation and coaggregation of history of hypertension and stroke. J Hum Hypertens. 2005;19:119–25.PubMedCrossRefGoogle Scholar
  9. 9.
    DeStefano A, Gavras H, Heard-Costa N, Bursztyn M, Manolis A, Farrer L, et al. Maternal component in the familial aggregation of hypertension. Clin Genet. 2001;60(1):13–21.PubMedCrossRefGoogle Scholar
  10. 10.
    Wada K, Tamakoshi K, Yatsuya H, Otsuka R, Murata C, Zhang H, et al. Association between parental histories of hypertension, diabetes and dyslipidemia and the clustering of these disorders in offspring. Prev Med (Baltim). 2006;42(5):358–63.CrossRefGoogle Scholar
  11. 11.
    Fuentes RM, Notkola IL, Shemeikka S, Tuomilehto J, Nissinen A. Familial aggregation of blood pressure: a population-based family study in eastern Finland. J Hum Hypertens. 2000;14(7):441–5.PubMedCrossRefGoogle Scholar
  12. 12.
    Lascaux-Lefebvre V, Ruidavets J, Arveiler D, Amouyel P, Haas B, Cottel D, et al. Influence of parental history of hypertension on blood pressure. J Hum Hypertens. 1999;13(9):631–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Wang N-Y, Young JH, Meoni LA, Ford DE, Erlinger TP, Klag MJ. Blood pressure change and risk of hypertension associated with parental hypertension: the Johns Hopkins precursors study. Arch Intern Med. 2008;168(6):643–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Bell AC, Adair LS, Popkin BM. Ethnic differences in the association between body mass index and hypertension. Am J Epidemiol. 2002;155(4):346–53.CrossRefGoogle Scholar
  15. 15.
    Gus M, Fuchs SC, Moreira LB, Moraes RS, Wiehe M, Silva AF, et al. Association between different measurements of obesity and the incidence of hypertension. Am J Hypertens. 2004;17(1):50–3.PubMedCrossRefGoogle Scholar
  16. 16.
    Olinto MTA, Nacul LC, Gigante DP, Costa JSD, Menezes AMB, Macedo S. Waist circumference as a determinant of hypertension and diabetes in Brazilian women: a population-based study. Public Health Nutr. 2004;7(5):629–35.PubMedCrossRefGoogle Scholar
  17. 17.
    Hirani V, Zaninotto P, Primatesta P. Generalised and abdominal obesity and risk of diabetes, hypertension and hypertension-diabetes co-morbidity in England. Public Health Nutr. 2008;11(5):521–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Guagnano MT, Ballone E, Colagrande V, Della Vecchia R, Manigrasso MR, Merlitti D, et al. Large waist circumference and risk of hypertension. Int J Obes. 2001;25(9):1360–4.CrossRefGoogle Scholar
  19. 19.
    Gelber R, Gaziano M, Manson J, Buring J, Sesso H. A prospective study of body mass index and the risk of developing hypertension in men. Am J Hypertens. 2007;20(4):370–7.PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    Okosun IS, Prewitt TE, Cooper RS. Abdominal obesity in the United States: prevalence and attributable risk of hypertension. J Hum Hypertens. 1999;13(7):425–30.PubMedCrossRefGoogle Scholar
  21. 21.
    Okosun I, Choi S, Dent M, Jobin T, GEA D. Abdominal obesity defined as a larger than expected waist girth is associated with racial/ethnic differences in risk of hypertension. J Hum Hypertens. 2001;15:307–12.PubMedCrossRefGoogle Scholar
  22. 22.
    Ostchega Y, Hughes JP, Terry A, Fakhouri THI, Miller I. Abdominal obesity, body mass index, and hypertension in US adults: NHANES 2007-2010. Am J Hypertens. 2012;25(12):1271–8.PubMedGoogle Scholar
  23. 23.
    Doll S, Paccaud F, Bovet P, Burnier M, Wietlisbach V. Body mass index, abdominal adiposity and blood pressure: consistency of their association across developing and developed countries. Int J Obes. 2002;26(1):48–57.CrossRefGoogle Scholar
  24. 24.
    Fujita M, Hata A. Sex and age differences in the effect of obesity on incidence of hypertension in the Japanese population: a large historical cohort study. J Am Soc Hypertens. 2014;8(1):64–70.PubMedCrossRefGoogle Scholar
  25. 25.
    Halperin RO, Sesso HD, Ma J, Buring JE, Stampfer MJ, Gaziano JM. Dyslipidemia and the risk of incident hypertension in men. Hypertension. 2006;47(1):45–50.PubMedCrossRefGoogle Scholar
  26. 26.
    Otsuka T, Takada H, Nishiyama Y, Kodani E, Saiki Y, Kato K, et al. Dyslipidemia and the risk of developing hypertension in a working-age male population. J Am Heart Assoc. 2015;5(3):1–9.Google Scholar
  27. 27.
    Ansell BJ. Evidence for a combined approach to the management of hypertension and dyslipidemia. Am J Hypertens. 2005;18(9 Pt 1):1249–57.PubMedCrossRefGoogle Scholar
  28. 28.
    Street D, Anderson GJ, Wagner S. Effect of age on response of secondary hypertension to specific treatment. Am J Hypertens. 1990;3(5):360–5.CrossRefGoogle Scholar
  29. 29.
    Vathesatogkit P, Woodward M, Tanomsup S, Hengprasith B, Aekplakorn W, Yamwong S, et al. Long-term effects of socioeconomic status on incident hypertension and progression of blood pressure. J Hypertens. 2012;30:1347–53.PubMedCrossRefGoogle Scholar
  30. 30.
    James S, Strogatz D, Wing S, Ramsey D. Socioeconomic status, John Henryism, and hypertension in blacks and whites. Am J Epidemiol. 1987;126(4):664–73.PubMedCrossRefGoogle Scholar
  31. 31.
    Pickering T. Cardiovascular pathways: socioeconomic status and stress effects on hypertension and cardiovascular function. Ann N Y Acad Sci. 1999;896:262–77.PubMedCrossRefGoogle Scholar
  32. 32.
    Byrd JB, Brook R. Anxiety in the ‘age of hypertension’. Curr Hypertens Rep. 2014;16(10):1–7.CrossRefGoogle Scholar
  33. 33.
    McGrady A, Higgins J. Effect of repeated measurements of blood pressure in essential hypertension: role of anxiety. J Behav Med. 1990;13(1):93–101.PubMedCrossRefGoogle Scholar
  34. 34.
    Krousel-Wood M, Frohlich E. Hypertension and depression: coexisting barriers to medication adherence. J Clin Hypertens. 2010;12(7):481–6.Google Scholar
  35. 35.
    Kretchy I, Owusu-Daaku F, Danquah S. Mental health in hypertension: assessing symptoms of anxiety, depression and stress on anti-hypertensive medication adherence. Int J Ment Health Syst. 2014;8(25):1–6.Google Scholar
  36. 36.
    Maatouk I, Herzog W, Bohlen F, Quinzler R, Saum K-U, Brenner H, et al. Association of hypertension with depression and generalized anxiety symptoms in a large population-based sample of older adults. J Hypertens. 2016;34:1711–20.PubMedCrossRefGoogle Scholar
  37. 37.
    • Jackson C, Pathirana T, Gardiner P. Depression, anxiety and risk of hypertension in mid-aged women: a prospective longitudinal study. J Hypertens. 2016;34:1959–66. This study makes an important contribution in understanding the pathogenesis of hypertension by documenting various moderating and mediating effects in causal models. For example, the results show that the relationship between depression and hypertension is mediated by the influence of other variables such as body mass index. PubMedCrossRefGoogle Scholar
  38. 38.
    Kabir AA, Whelton P, Khan M, Gustat J, Chen W. Association of symptoms of depression and obesity with hypertension: the Bogalusa Heart Study. Am J Hypertens. 2006;19(6):639–54.PubMedCrossRefGoogle Scholar
  39. 39.
    Gangwisch J, Malaspina D, Posner K, Babiss S, Lindsay Heymsfield B, Turner GZ, et al. Insomnia and sleep duration as mediators of the relationship between depression and hypertension incidence. Am J Hypertens. 2010;23(1):62–9.PubMedCrossRefGoogle Scholar
  40. 40.
    Saboya P, Zimmermann P, Bodanese L. Association between anxiety or depressive symptoms and arterial hypertension, and their impact on the quality of life. Int J Psychiatry Med. 2010;40(3):307–20.PubMedCrossRefGoogle Scholar
  41. 41.
    Wei T-M, Wang L. Anxiety symptoms in patients with hypertension: a community-based study. Int J Psychiatry Med. 2006;36(3):315–22.PubMedCrossRefGoogle Scholar
  42. 42.
    Player M, Person L. Anxiety disorders, hypertension, and cardiovascular risk: a review. Int J Psychiatry Med. 2011;41(4):365–77.PubMedCrossRefGoogle Scholar
  43. 43.
    Dorobanțu M, Darabont R, Dimulescu D, Sinescu C, Tatomir PG, Arsenescu Georgescu C, et al. New national epidemiological survey for the assessment of trend in hypertension’s prevalence, treatment and control among the adult population of Romania: SEPHAR III—design and methodology. J Hypertens Res. 2016;2(4):143–52.Google Scholar
  44. 44.
    •• Piepoli M, Hoes A, Agewal S, Albus C, Brotons C, Catapano A, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2016;37(29):2315–81. This document represents an evidence-based scientific consensus on the main practices in the control and prevention of hypertension. PubMedPubMedCentralCrossRefGoogle Scholar
  45. 45.
    Winkleby M, Jatulis D, Frank E, Fortmann S. Socioeconomic status and health: how education, income, and occupation contribute to risk factors for cardiovascular disease. Am J Public Health. 1992;82(6):816–20.PubMedPubMedCentralCrossRefGoogle Scholar
  46. 46.
    European Commission, Educational attainment statistics, Eurosta: Statistics Explained, 2016. [Online]. Available: [Accessed: 01-Jan-2017].
  47. 47.
    European Commission, Gini coefficient of equivalised disposable income—EU-SILC survey, Eurostat: Your Key to European Statistics, 2017. [Online] Available: [Accessed: 01-Jan-2017].
  48. 48.
    Sandu D. Social disparities in the regional development and policies of Romania. Int Rev Soc Res. 2011;1(1):1–30.CrossRefGoogle Scholar
  49. 49.
    Verdery K. National ideology under socialism: identity and cultural politics in Ceausescu’s Romania: University of California Press; 1991.Google Scholar
  50. 50.
    Kroenke K, Spitzer R, Williams J. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;19(9):606–13.CrossRefGoogle Scholar
  51. 51.
    Keys A, Fidanza F, Karvonen M, Kimura N, Taylor H. Indices of relative weight and obesity. J Chronic Dis. 1972;25(6–7):329–43.PubMedCrossRefGoogle Scholar
  52. 52.
    US Department of Health and Human Service, ATP III guidelines at-a-glance: Quick desk reference. US Department of Health and Human Service, 2001.Google Scholar
  53. 53.
    Reiner Z, Catapano A, De Backer G, Graham I, Taskinen M-R, Wiklund O, et al. ESC/EAS guidelines for the management of dyslipidaemias. Eur Heart J. 2011;32:1769–818.PubMedCrossRefGoogle Scholar
  54. 54.
    • Baek T-H, Lee H-Y, Lim N-K, Park H-Y. Gender differences in the association between socioeconomic status and hypertension incidence: the Korean Genome and Epidemiology Study (KoGES). BMC Public Health. 2015;15(1):852–9. This study highlights the need for gender-differentiated policy measures in public health. The results show statistically significant gender differences in the association between hypertension incidence and socioeconomic status. PubMedPubMedCentralCrossRefGoogle Scholar
  55. 55.
    • Rughiniș C, Humă B. Who theorizes age? The ‘socio-demographic variables’ device and age–period–cohort analysis in the rhetoric of survey research. J Aging Stud. 2015;35:144–59. This critical analysis shows that age is inadvertantly used as a quasi-biological feature in survey research. Scholars and practitionars are invited to understand the social nature of age and be more reflective in the interpretation of causal models. PubMedCrossRefGoogle Scholar
  56. 56.
    Bodogai S, Cutler S. Aging in Romania: research and public policy. The Gerontolgist. 2014;54(2):147–52.CrossRefGoogle Scholar
  57. 57.
    Dorobantu M, Tautu O-F, Dimulescu D, Sinescu C, Gusbeth-Tatomir C, Arsenescu-Gerogescu P, et al. Perspectives on hypertension’s prevalence, treatment and control in a high cardiovascular risk East European country: data from the SEPHAR III survey. J Hypertens. 2017.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Ștefania Matei
    • 1
    • 2
    Email author
  • Stephen J. Cutler
    • 2
    • 3
  • Marian Preda
    • 2
  • Maria Dorobanțu
    • 4
  • Corina Ilinca
    • 2
  • Oana Gheorghe-Fronea
    • 4
  • Luminița Rădulescu
    • 4
    • 5
  • Nicoleta Oprescu
    • 4
  • Alexandru Deaconu
    • 4
  • Corina Zorilă
    • 6
  • Bogdan Dorobanțu
    • 4
  1. 1.Division of Social SciencesResearch Institute of the University of BucharestBucharestRomania
  2. 2.Faculty of Sociology and Social WorkUniversity of BucharestBucharestRomania
  3. 3.Department of SociologyUniversity of VermontBurlingtonUSA
  4. 4.Carol Davila” University of Medicine and PharmacyBucharestRomania
  5. 5.Emergency Clinical Hospital of BucharestBucharestRomania
  6. 6.“Vasile Goldiş” Western University of AradFaculty of MedicineAradRomania

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