The influence of marital adjustment on 3-year left ventricular mass and ambulatory blood pressure in mild hypertension

Background: Of psychosocial stressors, job strain has been associated with a sustained increase in blood pressure. The impact of marital factors on bl ood 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 ind ex (LVMI) and ambulatory blood pressure measured over 3 years in patients w ith mild hypertension. Methods: A prospective cohort study was conducted on 103 cohabiting males o r females, including 72 with technically adequate echocardiograms, who at b aseline were unmedicated, employed, and living with a significant other, al l for a minimum of 6 months and had repeated elevated office diastolic bloo d pressure. Main Outcome Measures: Left ventricular mass by M-mode echocardiography ind exed to body surface area and blood pressure were measured by ambulatory bl ood pressure every 15 minutes (daytime) and hourly between 11 PM and 7 AM. Results: Marital adjustment, smoking, drinking, and baseline LVMI contribut ed significantly to the prediction of 3-year LVMI (semipartial correlation, sr(2), 0.04, 0.07, 0.03, and 0.22, P = .03, .008, .08, and <.001, respecti vely) together accounting for 36% of the total variability in follow-up LVM I. Three-year ambulatory blood pressure measures were not significantly rel ated to marital adjustment but there were correlations with Dyadic Adjustme nt Scale subscales. Low or high levels of spousal contact during 3-year amb ulatory blood pressure monitoring were associated with an increase or decre ase of 3-year, 24-hour diastolic blood pressure, consistent with the qualit y of marital adjustment (P = .04) or marital satisfaction (Dyadic Adjustmen t Scale subscale, P = .008). Conclusions: In a cohort of subjects with mild essential hypertension, mari tal adjustment had an influence on 3-year LVMI. Depending on the quality of marital adjustment, spousal contact at 3 years was associated with an incr ease or decrease of 3-year diastolic blood pressure. Confirmation of these results, including objective marital assessment and the participation of no rmotensive subjects, is required.