Teenagers with high blood pressure appear to have better psychological adjustment and enjoy higher quality of life than those with normal blood pressure, suggests a study in the May issue ofPsychosomatic Medicine: Journal of Biobehavioral Medicine, the official journal of the American Psychosomatic Society. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

“This is the first report linking elevated blood pressure to quality of life and psychosocial adaptation in a large epidemiological study of adolescents,” according to the report by Dr Angela Berendes of University of Göttingen, Germany, and colleagues. The authors speculate on some possible reasons for their surprising results—including “repressed emotions” or even a “stress-dampening effect” of high blood pressure (hypertension).

The researchers analyzed data on blood pressure, quality of life, and psychological distress in approximately 7,700 teenagers from a German nationwide study. Overall 10.7 percent of the teens had high blood pressure—a rate about twice as high as expected.

Not surprisingly, adolescents with hypertension were more likely to be obese and less physically fit than those with normal blood pressure. They spent more time watching TV or playing video games and had more adverse health behaviors, including alcohol consumption.

But unexpectedly, teens with high blood pressure were better off in several ways—including being more academically successful than those with normal blood pressure. Quality of life was also rated better by adolescents with high blood pressure, with higher scores in the areas of family life, self-esteem, and physical well-being.

The difference in quality of life remained significant after adjustment for other factors, and was supported by parental ratings of fewer emotional, conduct, and other problems. Teens with high blood pressure were also less likely to have problems with hyperactivity.

Associations May Reflect High Achievement, Repressed Emotions, or…?

High blood pressure is one of the most frequent chronic conditions, leading to high rates of illness and death. It can remain asymptomatic for years, causing blood vessel and organ damage if not detected and controlled.

Hypertension may start in childhood and adolescence, persisting into adulthood. Previous studies have found lower levels of psychological distress in adults who have high blood pressure but are unaware of it. In contrast, quality of life appears to be reduced for patients whose hypertension is diagnosed and treated.

The new study finds similar, “seemingly contradictory” results in adolescents. Although their study can’t conclusively explain the associations, Dr Berendes and coauthors discuss some possible theories:

Teens who are more achievement-oriented and do better in school may experience increased stress, leading to higher blood pressure—but also to better self-esteem and quality of life.

Some teens may repress their negative emotions, causing them to have higher blood pressure—as well as to give higher ratings of psychological functioning and quality of life.

High blood pressure may actually act to dampen negative emotions—some studies have suggested that a rise in blood pressure may reduce perceived stress.

Whatever the explanations, the new study finds highly consistent links between high blood pressures, lower distress, and higher quality of life, suggesting “a real and epidemiologically relevant association,” Dr Berendes and coauthors conclude. More research is needed to clarify the study implications—particularly in young patients who are unaware of and have yet to experience long-term damage related to high blood pressure.