Association of elevated blood pressure with low distress and good quality of life: results from the nationwide representative German Health Interview and Examination Survey for Children and Adolescents

Psychosom Med. 2013 May;75(4):422-8. doi: 10.1097/PSY.0b013e31828ef0c2.


Objective: Quality of life is often impaired in patients with known hypertension, but it is less or not at all reduced in people unaware of their elevated blood pressure. Some studies have even shown less self-rated distress in adults with elevated blood pressure. In this substudy of the nationwide German Health Interview and Examination Survey for Children and Adolescents (KIGGS), we addressed the question whether, also in adolescents, hypertensive blood pressure is linked to levels of distress and quality of life.

Methods: Study participants aged 11 to 17 years (N = 7688) received standardized measurements of blood pressure, quality of life (using the Children's Quality of Life Questionnaire), and distress (Strengths and Difficulties Questionnaire).

Results: Elevated blood pressure was twice as frequent as expected, with 10.7% (n = 825) above published age-, sex- and height-adjusted 95th percentiles. Hypertensive participants were more likely to be obese and to report on adverse health behaviors, but they showed better academic success than did normotensive participants. Elevated blood pressure was significantly and positively associated with higher self- and parent-rated quality of life (for both, p ≤ .006), less hyperactivity (for both, p < .005), and lower parent-rated emotional (p < .001), conduct (p = .021), and overall problems (p = .001). Multiple regression analyses confirmed these findings.

Conclusions: Our observation linking elevated blood pressure to better well-being and low distress can partly be explained by the absence of confounding physical comorbidity and the unawareness of being hypertensive. It also corresponds to earlier research suggesting a bidirectional relationship with repressed emotions leading to elevated blood pressure and, furthermore, elevated blood pressure serving as a potential stress buffer.

Keywords: adolescents; blood pressure; health-related quality of life; hypertension.

MeSH terms

  • Adolescent
  • Adolescent Behavior
  • Alcohol Drinking / epidemiology
  • Asymptomatic Diseases
  • Blood Pressure / physiology*
  • Child
  • Child Behavior
  • Child, Preschool
  • Educational Status
  • Emotions
  • Female
  • Germany / epidemiology
  • Humans
  • Hypertension / epidemiology
  • Hypertension / psychology*
  • Leisure Activities
  • Male
  • Obesity / epidemiology
  • Parents / psychology
  • Quality of Life*
  • Repression, Psychology
  • Sedentary Behavior
  • Stress, Psychological / epidemiology
  • Stress, Psychological / physiopathology*
  • Surveys and Questionnaires