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From the Office of Analysis (B.S.J.), Epidemiology and Health Promotion, National Center for Health Statistics, US Centers for Disease Control and Prevention, Hyattsville, MD; and Epidemiology Program Office (J.F.L.), US Centers for Disease Control and Prevention, Atlanta, GA.
OBJECTIVE: The objective of this study was to test the hypothesis that negative affect is a prospective risk factor for hypertension among white and black persons.
METHODS: A population-based cohort of 3310 initially normotensive and chronic disease–free persons in the NHANES I Epidemiologic Follow-up Study was tracked through four follow-up waves (maximum, 22 years). The association between hypertension and baseline negative affect was analyzed using Cox proportional hazards regression, adjusting for baseline age, sex, race, education, smoking, alcohol use, diastolic and systolic blood pressure, body mass index, and change in body mass index as a time-dependent covariate. Negative affect was based on combined symptoms of depression and anxiety. Hypertension end points included 1) self-reported, 2) treated (prescription of antihypertensive medications), and 3) incident (blood pressure 
160/95 mm Hg or treated) hypertension. Blood pressure measurements were obtained only at baseline and the first follow-up examination (maximum, 13 years).
RESULTS: Increased negative affect was associated with elevated risk for self-reported, treated, and incident hypertension at first follow-up. Through four waves of follow-up, high negative affect was associated with treated hypertension in baseline risk–adjusted models for white women (relative risk [RR] = 1.73, 95% confidence interval [95% CI] = 1.30–2.30), black women (RR = 3.12, 95% CI = 1.24–7.88), and all men (RR = 1.56, 95% CI = 1.08–2.25). Time-dependent covariate models produced similar RRs.
CONCLUSIONS: Negative affect is predictive of development of hypertension. For treated hypertension, white women and all men with increased negative affect had similarly elevated RRs, whereas black women with increased negative affect had substantially higher RRs.
Key Words: negative affect • anxiety • depression • hypertension • longitudinal • incidence
Abbreviations: CI = confidence interval; BMI = body mass index; DBP = diastolic blood pressure; GWB-A = General Well-Being Schedule, Relaxed vs. Anxious scale; GWB-D = General Well-Being Schedule, Cheerful vs. Depressed scale; NHANES I = first National Health and Nutrition Examination Survey; NHEFS = NHANES I Epidemiologic Follow-up Study; RR = relative risk; SBP = systolic blood pressure.
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