DOI: 10.1161/jaha.123.030765 ISSN: 2047-9980

Spousal Concordance of Hypertension Among Middle‐Aged and Older Heterosexual Couples Around the World: Evidence From Studies of Aging in the United States, England, China, and India

Jithin Sam Varghese, Peiyi Lu, Daesung Choi, Lindsay C. Kobayashi, Mohammed K. Ali, Shivani A. Patel, Chihua Li
  • Cardiology and Cardiovascular Medicine


Health concordance within couples presents a promising opportunity to design interventions for disease management, including hypertension. We compared the concordance of prevalent hypertension within middle‐aged and older heterosexual couples in the United States, England, China, and India.

Methods and Results

Cross‐sectional dyadic data on heterosexual couples were used from contemporaneous waves of the HRS (US Health and Retirement Study, 2016/17, n=3989 couples), ELSA (English Longitudinal Study on Aging, 2016/17, n=1086), CHARLS (China Health and Retirement Longitudinal Study, 2015/16, n=6514), and LASI (Longitudinal Aging Study in India, 2017/19, n=22 389). Concordant hypertension was defined as both husband and wife in a couple having hypertension. The prevalence of concordant hypertension within couples was 37.9% (95% CI, 35.8–40.0) in the United States, 47.1% (95% CI, 43.2–50.9) in England, 20.8% (95% CI, 19.6–21.9) in China, and 19.8% (95% CI, 19.0–20.5) in India. Compared with wives married to husbands without hypertension, wives married to husbands with hypertension were more likely to have hypertension in the United States (prevalence ratio, 1.09 [95% CI, 1.01– 1.17), England (prevalence ratio, 1.09, 95% CI, 0.98–1.21), China (prevalence ratio, 1.26 [95% CI, 1.17–1.35), and India (prevalence ratio, 1.19 [95% CI, 1.15–1.24]). Within each country, similar associations were observed for husbands. Across countries, associations in the United States and England were similar, whereas they were slightly larger in China and India.


Concordance of hypertension within heterosexual couples was consistently observed across these 4 socially and economically diverse countries. Couple‐centered interventions may be an efficient strategy to prevent and manage hypertension in these countries.

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