The association of hypertension among married Indian couples: a nationally representative cross-sectional study

Abstract

Mounting evidence demonstrates that intimate partners sharing risk factors have similar propensities for chronic conditions such as hypertension. The objective was to study whether spousal hypertension was associated with one's own hypertension status independent of known risk factors, and stratified by socio-demographic subgroups (age, sex, wealth quintile, caste endogamy). Data were from heterosexual married couples (n = 50,023, women: 18-49 years, men: 21-54 years) who participated in the National Family Health Survey-V (2019-2021). Hypertension was defined as self-reported diagnosis of hypertension or average of three blood pressure measurements ≥ 140 systolic or 90 mmHg diastolic BP. Among married adults, the prevalence of hypertension among men (38.8 years [SD 8.3]) and women (33.9 years [SD 7.9]) were 29.1% [95% CI 28.5-29.8] and 20.6% [95% CI 20.0-21.1] respectively. The prevalence of hypertension among both partners was 8.4% [95% CI 8.0-8.8]. Women and men were more likely to have hypertension if their spouses had the condition (husband with hypertension: PR 1.37 [95% CI 1.30-1.44]; wife with hypertension: PR 1.32 [95% CI 1.26-1.38]), after adjusting for known risk factors. Spouse's hypertension status was consistently associated with own status across all socio-demographic subgroups examined. These findings present opportunities to consider married couples as a unit in efforts to diagnose and treat hypertension.

Keywords: Hypertension; India; Low- and middle-income country; Spousal concordance.

Figure 1

Prevalence of co-occurrent hypertension in married Indian couples, n = 50,023. Co-occurrent hypertension was defined as both spouses having the respective disease. The marginal and co-occurrent prevalence of disease are provided in Supplementary Table 3. The above figure was generated using the R package tmap version 3.3–3.

Figure 2

Stratum-specific prevalence ratio by socio-demographic groups, n = 50,023. Association of spousal disease status with own disease status for Hypertension: diagnosed or SBP/DBP ≥ 140/90 mmHg. Estimates are available in Supplementary Table 2. All models adjusted for individual (age, schooling, body mass index, number of children, alcohol and tobacco use), and household (household members, number of children, rurality, wealth quintile) factors and state fixed-effects.