Ask an Expert: Shared Blood Pressure and Health Habits Among Couples With Jithin Sam Varghese
By Kelly Jordan
When sharing a household with others, it’s common for people to adopt the habits of those they live with—good and bad. It’s a topic that Rollins researcher, Jithin Sam Varghese, PhD, assistant research professor, spends a lot of time thinking about. As a researcher with the Emory Global Diabetes Research Center and Hubert Department of Global Health, his work spans three key domains: understanding how subgroups of cardiometabolic disease are present in the population, studying the burden of undiagnosed and untreated cardiometabolic disease, and focusing on how spouses’ health behaviors change over time.
Most recently, he was lead author on a piece published the Journal of the American Heart Association that found that married middle-aged and older heterosexual adults are more likely to have high blood pressure if their spouse has it too.
Heart disease remains the No. 1 killer of Americans across genders. “While deaths from heart disease have been falling in the U.S. over time due to improved diagnosis and management, there are large and persistent socio-economic and racial-ethnic disparities,” says Varghese. “Hypertension is the leading cause of death from heart disease and stroke in the U.S. and nearly half of U.S. adults have hypertension. About one in seven are undiagnosed, and only one in four adults with hypertension have their blood pressure under control. Controlling blood pressure is especially important in terms of both preventing heart disease or mortality from heart disease, but also in terms of preventing complications of diseases such as diabetes.”
Here, Varghese talks shared health behaviors among couples, recent research, and what’s next.
People at risk for heart disease may also be at risk for other co-morbidities, like diabetes. How can people limit their risk of developing either disease?
Maintaining a healthy lifestyle is very important. That includes getting good-quality and sufficient sleep, managing stress, having a healthy diet, not smoking, limiting alcohol, and meeting physical activity recommendations. Getting guideline recommended screening for hypertension and diabetes—especially if you know you’re at risk—is also important.
Some of that is easier said than done, particularly when we’re talking about access issues.
Socioeconomic and structural disparities exist all over the world. People that do not have access to routine screening or to routine management strategies often end up being the same ones who tend to develop the disease early and experience disparities in mortality or adverse complications from the disease. This is an area we should focus on deeply considering that these differences exist not only in terms of earlier ages of onset of hypertension and diabetes among the Black and Hispanic populations, but they also tend to have worse prognosis after diagnosis.
Talk a bit about the shared blood pressure study that was recently published. What group were you specifically looking at and what did you find?
We looked at couples’ blood pressures in four large countries that differ widely in their socioeconomic, cultural, and health contexts: the United States, England, China, and India. We found that the prevalence of shared hypertension, or high blood pressure (>140/90 mmHg), was about 38% in the U.S., 47% in England, 21% in China, and 20% in India. The prevalence of shared hypertension between couples was greater in the U.S. and England compared to China and India, likely due to couples being older and therefore having spent a longer time together in shared lifestyles. Hypertension was present among both individuals in a couple across different categories of age, wealth, schooling, and length of marriage. We also saw that the likelihood of an individual having hypertension if their partner had it was stronger in China and India compared to the U.S. and England.
How can these findings inform future public health interventions?
It's a way of identifying people who do not know if they have the disease through their partner, and to identify new ways of incentivizing blood pressure screening and management at the policy level, especially in populations with high rates of undiagnosed and uncontrolled blood pressure. Now, early detection of hypertension and management of blood pressure is important because it can prevent complications like heart disease and stroke. It can also help public health departments understand the burden in their communities better and provide new opportunities for raising awareness for healthy living at the family level. From a clinical perspective, it may be helpful to treat couples as opposed to individuals—encouraging patients to consider joint management strategies and holding each other accountable. And from the science standpoint, the mechanism of how couples develop blood pressure together is important to understand. For instance, how do shared household environments and marital relationships contribute to a shared burden of habitation?
Where do you plan on taking this research next?
We are trying to understand how living together influences health risks over time in couples. Do couples share risk because they had similar behaviors when they first met, or did their behaviors and health outcomes become more similar over time due to partners influencing one another? Also, what about other groups of people that haven’t been studied yet? Dr. Sophia Hussen and I want to study shared health behaviors in gay couples in the U.S., specifically Black sexual minority men, to better understand how relationships impact health in this population. Dr. Shivani Patel is leading a large study of 1,500 couples in India where she's giving couples wearable health monitors to jointly track their sleep and physical activity, as well as other health behaviors, with the goal of trying to identify health behaviors that could be targeted for couples-based health promotion.
