Both High and Low Levels of Negative Emotions Are Associated with Higher Blood Pressure: Evidence from Whitehall II Cohort Study

  • Nadya DichEmail author
  • Naja Hulvej Rod
  • Stacey N. Doan
Full length manuscript



Previous studies of negative emotions and blood pressure (BP) produced mixed findings. Based on the functionalist and evolutionary perspective on emotions, we hypothesized that the association between negative emotions and BP is U-shaped, i.e., that both very high levels of negative emotions and the absence thereof are related to high BP.


Data from 7479 British civil servants who participated in Phases 1–11 (years 1985–2013) of the Whitehall II cohort study was used. Negative emotions were operationalized as negative affect and depressive and anxiety symptoms. Negative affect was measured at Phases 1 and 2. Anxiety and depressive symptoms were assessed at each phase. BP was measured at every other phase. For each negative emotion measure, an average across all phases was computed and used as a predictor of PB levels throughout the follow-up period using growth curve models.


Very high values of anxiety and depressive symptoms, but not negative affect, were associated with higher levels of systolic BP. However, low to moderate levels of all negative emotions were associated with lower blood pressure than the absence of negative emotions.


The article offers a theoretical explanation for a previously observed inverse association between negative emotions and blood pressure and underscores that moderate levels of negative emotions that naturally occur in everyday life are not associated with risks of heightened blood pressure.


Negative emotions Anxiety Depression Blood pressure 


Funding Information

This work was supported by a grant from the Danish Research Council (DFF 4183–00474) to ND.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

Statement of Informed Consent

The Whitehall II study is approved by the London-Harrow Research Ethics Committee and the Scotland Research Ethics Committee. All participants who had clinical examination were asked to give written informed consent.

Supplementary material

12529_2019_9844_MOESM1_ESM.docx (46 kb)
ESM 1 (DOCX 46 kb)


  1. 1.
    Kubzansky LD, Kawachi I. Going to the heart of the matter: do negative emotions cause coronary heart disease? J Psychosom Res. 2000;48:323–37.CrossRefGoogle Scholar
  2. 2.
    Steptoe A, Kivimäki M. Stress and cardiovascular disease: an update on current knowledge. Annu Rev Public Health. 2013;34:337–54.CrossRefGoogle Scholar
  3. 3.
    Suls J, Bunde J. Anger, anxiety, and depression as risk factors for cardiovascular disease: the problems and implications of overlapping affective dispositions. Psychol Bull. 2005;131:260–300.CrossRefGoogle Scholar
  4. 4.
    Negative Emotions Can Increase the Risk of Heart Disease. Psychol. Today. (accessed 10 Jan2019).
  5. 5.
    Many Emotions Can Damage the Heart. WebMD. (accessed 10 Jan2019).
  6. 6.
    Cohen S, Janicki-Deverts D, Miller GE. Psychological stress and disease. JAMA. 2007;298:1685–7.CrossRefGoogle Scholar
  7. 7.
    Maatouk I, Herzog W, Böhlen F, Quinzler R, Löwe B, Saum K-U, 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.CrossRefGoogle Scholar
  8. 8.
    Shinagawa M, Otsuka K, Murakami S, Kubo Y, Cornelissen G, Matsubayashi K, et al. Seven-day (24-h) ambulatory blood pressure monitoring, self-reported depression and quality of life scores. Blood Press Monit. 2002;7:69–76.CrossRefGoogle Scholar
  9. 9.
    Bhat SK, Beilin LJ, Robinson M, Burrows S, Mori TA. Relationships between depression and anxiety symptoms scores and blood pressure in young adults. J Hypertens. 2017;35:1983–91.CrossRefGoogle Scholar
  10. 10.
    Hildrum B, Romild U, Holmen J. Anxiety and depression lowers blood pressure: 22-year follow-up of the population based HUNT study. Norway BMC Public Health. 2011;11:601.Google Scholar
  11. 11.
    Grimsrud A, Stein DJ, Seedat S, Williams D, Myer L. The association between hypertension and depression and anxiety disorders: results from a nationally-representative sample of south African adults. PLoS One. 2009;4:e5552.CrossRefGoogle Scholar
  12. 12.
    Shinn EH, Poston WS, Kimball KT, St Jeor ST, Foreyt JP. Blood pressure and symptoms of depression and anxiety: a prospective study. Am J Hypertens. 2001;14:660–4.CrossRefGoogle Scholar
  13. 13.
    Keltner D, Haidt J, Shiota MN. Social functionalism and the evolution of emotions. In: Evolution and social psychology. New York: Psychology Press; 2006. p. 115–42.Google Scholar
  14. 14.
    Keltner D, Gross JJ. Functional accounts of emotions. Cogn Emot. 1999;13:467–80.CrossRefGoogle Scholar
  15. 15.
    Rando TA. Treatment of complicated mourning. Champlian, IL: Research Press; 1993.Google Scholar
  16. 16.
    Cole PM, Michel MK, Teti LO. The development of emotion regulation and dysregulation: a clinical perspective. Monogr Soc Res Child Dev. 2008;59:73–102.CrossRefGoogle Scholar
  17. 17.
    Zautra AJ. Emotions, stress, and health. New York, NY, US: Oxford University Press; 2003.Google Scholar
  18. 18.
    Wang M, Park Y, Lee KR. Korean-English Biliteracy acquisition: cross-language phonological and orthographic transfer. J Educ Psychol. 2006;98:148–58.CrossRefGoogle Scholar
  19. 19.
    Joiner TE, Schmidt KL, Metalsky GI. Low-end specificity of the Beck depression inventory. Cognit Ther Res. 1994;18:55–68.CrossRefGoogle Scholar
  20. 20.
    Adler JM, Hershfield HE. Mixed emotional experience is associated with and precedes improvements in psychological well-being. PLoS One. 2012;7:e35633.CrossRefGoogle Scholar
  21. 21.
    Pennebaker JW, Graybeal A. Patterns of natural language use: disclosure, personality, and social integration. Curr Dir Psychol Sci. 2001;10:90–3.CrossRefGoogle Scholar
  22. 22.
    Lepore SJ, Smyth JM. The writing cure: how expressive writing promotes health and emotional well-being. Washington, DC: American Psychological Association; 2002.CrossRefGoogle Scholar
  23. 23.
    Hershfield HE, Scheibe S, Sims TL, Carstensen LL. When feeling bad can be good: mixed emotions benefit physical health across adulthood. Soc Psychol Personal Sci. 2013;4:54–61.CrossRefGoogle Scholar
  24. 24.
    Eng PM, Fitzmaurice G, Kubzansky LD, Rimm EB, Kawachi I. Anger expression and risk of stroke and coronary heart disease among male health professionals. Psychosom Med. 2003;65:100–10.CrossRefGoogle Scholar
  25. 25.
    Gross JJ, Levenson RW. Hiding feelings: the acute effects of inhibiting negative and positive emotion. J Abnorm Psychol. 1997;106:95–103.CrossRefGoogle Scholar
  26. 26.
    Haynes S, Feinleib M, Kannel WB. The relationship of psychosocial factors to coronary heart disease in the Framingham study. III. Eight-year incidence of coronary heart disease. Am J Epidemiol. 1980;111:37–58.CrossRefGoogle Scholar
  27. 27.
    Seeman TE, McEwen BS, Rowe JW, Singer BH. Allostatic load as a marker of cumulative biological risk: MacArthur studies of successful aging. Proc Natl Acad Sci U S A. 2001;98:4770–5.CrossRefGoogle Scholar
  28. 28.
    Dich N, Doan SN, Kivimäki M, Kumari M, Rod NH. A non-linear association between self-reported negative emotional response to stress and subsequent allostatic load: prospective results from the Whitehall II cohort study. Psychoneuroendocrinology. 2014;49C:54–61.CrossRefGoogle Scholar
  29. 29.
    Goldberg DP. The detection of psychiatric illness by questionnaire. Oxford: Oxford University Press; 1972.Google Scholar
  30. 30.
    Virtanen M, Ferrie JE, Singh-Manoux A, Shipley MJ, Stansfeld SA, Marmot MG, et al. Long working hours and symptoms of anxiety and depression: a 5-year follow-up of the Whitehall II study. Psychol Med. 2011;41:2485–94.CrossRefGoogle Scholar
  31. 31.
    Bradburn NM, Noll CE. The structure of psychological well-being. Chicago, IL: Aldine; 1969.Google Scholar
  32. 32.
    Joas E, Guo X, Kern S, Östling S, Skoog I. Sex differences in time trends of blood pressure among Swedish septuagenarians examined three decades apart. J Hypertens. 2017;35:1424–31.CrossRefGoogle Scholar
  33. 33.
    Shimomitsu T, Theorell T. Intraindividual relationships between blood pressure level and emotional state. Psychother Psychosom. 1996;65:137–44.CrossRefGoogle Scholar
  34. 34.
    Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2016;37:2315–81.CrossRefGoogle Scholar
  35. 35.
    Gross JJ, Levenson RW. Emotional suppression: physiology, self-report, and expressive behavior. J Pers Soc Psychol. 1993;64:970–86.CrossRefGoogle Scholar
  36. 36.
    Gross JJ, John OP. Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being. J Pers Soc Psychol. 2003;85:348–62.CrossRefGoogle Scholar
  37. 37.
    Orsillo SM, Roemer L, Holowka DW. Acceptance-based behavioral therapies for anxiety. In: Acceptance and mindfulness-based approaches to anxiety. Boston, MA: Springer US; 2005. p. 3–35.CrossRefGoogle Scholar
  38. 38.
    Sorenson SB, Rutter CM, Aneshensel CS. Depression in the community : an investigation into age of onset. J Consult Clin Psychol. 1991;59:541–6.CrossRefGoogle Scholar
  39. 39.
    Ormel J, Rosmalen J, Farmer A. Neuroticism: a non-informative marker of vulnerability to psychopathology. Soc Psychiatry Psychiatr Epidemiol. 2004;39:906–12.CrossRefGoogle Scholar
  40. 40.
    Stewart JC, Perkins AJ, Callahan CM. Effect of collaborative care for depression on risk of cardiovascular events: data from the IMPACT randomized controlled trial. Psychosom Med. 2014;76:29–37.CrossRefGoogle Scholar
  41. 41.
    Lewer D, O’Reilly C, Mojtabai R, Evans-Lacko S. Antidepressant use in 27 European countries: associations with sociodemographic, cultural and economic factors. Br J Psychiatry. 2015;207:221–6.CrossRefGoogle Scholar

Copyright information

© International Society of Behavioral Medicine 2020

Authors and Affiliations

  1. 1.Department of Public HealthUniversity of CopenhagenCopenhagenDenmark
  2. 2.Department of PsychologyClaremont McKenna CollegeClaremontUSA

Personalised recommendations