Social connection and hypertension: a prospective cohort analysis

Abstract Background Components of social connection are associated with cardiovascular health, yet their specific roles in hypertension pathogenesis remain inadequately delineated, and their combined effects within the same dataset are also lacking. Purpose This study assessed both structural and functional social connection components within the same population to clarify their individual and combined effects on hypertension risk. Methods Analysis of 266,354 participants with complete data from the UK Biobank cohort. Social connection was assessed using two functional components (frequency of ability to confide in someone close and often feeling lonely) and three structural components (frequency of friends/family visits, weekly group activities, and living alone). Cox proportional hazards models were used to examine the associations with hypertension. Results Over a median follow-up of 14.1 years (IQR 12.7-14.8), 40,463 (15.2%) participants developed hypertension. For functional components, individuals who confided in close contacts less than monthly and those frequently experiencing loneliness were associated with a higher hypertension risk, demonstrating significant interaction effects. Specifically, among participants who never confide in others, lonely individuals exhibited substantially higher hypertension risk compared to their non-lonely counterparts (HR 1.27 1.21-1.32). For structural components, the absence of weekly group activities and living alone were independently associated with an elevated hypertension risk. Notably, the frequency of social contacts followed a non-linear relationship: compared to daily interactions with friends/family, monthly contact was associated with the lowest hypertension risk. This protective association persisted consistently across all subgroups, irrespective of variations in other functional or structural components. When all measures were combined into overall functional and structural components, there was an interaction between components: compared with participants defined as not isolated by both components, those considered isolated by both components had a higher hypertension risk (HR 1.24 1.21-1.28) than those isolated by each component alone (functional isolation HR 1.11 1.08-1.15; structural isolation HR 1.07 1.05-1.10). Conclusions Individuals with both functional and structural isolation are at an increased risk of hypertension. This work identifies a potential threshold effect for the frequency of confiding in others and suggests that individuals who feel lonely, particularly when combined with concurrent markers of structural isolation, may represent a high-risk population. Health policies targeting such reduced mental well-being could help alleviate the societal burden of hypertension.