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The Influence of Marital Adjustment on 3-Year Left Ventricular Mass and Ambulatory Blood Pressure in Mild Hypertension
Brian Baker, MBChB, FRCPC;
Miney Paquette, MSc;
John P. Szalai, PhD;
Helen Driver, PhD;
Tamara Perger, MSW;
Karin Helmers, PhD;
Brian O'Kelly, MD, FRCPC;
Sheldon Tobe, MD, FRCPC
Arch Intern Med. 2000;160:3453-3458.
Background Of psychosocial stressors, job strain has been associated with a sustained increase in blood pressure. The impact of marital factors on blood pressure and target organ has not been explored.
Objectives To evaluate whether marital adjustment, measured at baseline by self-report (Dyadic Adjustment Scale) influences left ventricular mass index (LVMI) and ambulatory blood pressure measured over 3 years in patients with mild hypertension.
Methods A prospective cohort study was conducted on 103 cohabiting males or females, including 72 with technically adequate echocardiograms, who at baseline were unmedicated, employed, and living with a significant other, all for a minimum of 6 months and had repeated elevated office diastolic blood pressure.
Main Outcome Measures Left ventricular mass by M-mode echocardiography indexed to body surface area and blood pressure were measured by ambulatory blood pressure every 15 minutes (daytime) and hourly between 11 PM and 7 AM.
Results Marital adjustment, smoking, drinking, and baseline LVMI contributed significantly to the prediction of 3-year LVMI (semipartial correlation, sr2 = 0.04, 0.07, 0.03, and 0.22; P = .03, .008, .08, and <.001, respectively) together accounting for 36% of the total variability in follow-up LVMI. Three-year ambulatory blood pressure measures were not significantly related to marital adjustment but there were correlations with Dyadic Adjustment Scale subscales. Low or high levels of spousal contact during 3-year ambulatory blood pressure monitoring were associated with an increase or decrease of 3-year, 24-hour diastolic blood pressure, consistent with the quality of marital adjustment (P = .04) or marital satisfaction (Dyadic Adjustment Scale subscale, P = .008).
Conclusions In a cohort of subjects with mild essential hypertension, marital adjustment had an influence on 3-year LVMI. Depending on the quality of marital adjustment, spousal contact at 3 years was associated with an increase or decrease of 3-year diastolic blood pressure. Confirmation of these results, including objective marital assessment and the participation of normotensive subjects, is required.
From the University of Toronto (Drs Baker, Driver, O'Kelly, Szalai, and Tobe); Department of Psychiatry (Drs Baker and Driver and Ms Perger) and the Division of Cardiology (Dr O'Kelly), University Health Network; Division of Cardiology, St Michael's Hospital (Ms Paquette); the Department of Research Design and Biostatistics (Dr Szalai), and the Division of Nephrology, Sunnybrook and Women's Health Sciences Centre (Dr Tobe), Toronto, Ontario; and the National Institute of Nursing Research, National Institute of Health, Bethesda, Md (Dr Helmers).
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