The silly season must be with us again, because two economists have done a study in Europe that correlates happiness with blood pressure. The higher the blood pressure, the less happy the people.

From a report on Medscape (registration required).

David G. Blanchflower, PhD (Dartmouth College, Hanover, New Hampshire) and Andrew J. Oswald, DPhil (University of Warwick, Coventry, UK) … have examined the relation between subjective measures of happiness and comparatively objective readings of blood pressure and found an inverse relation between the 2, ie, happy countries seem to have fewer blood-pressure problems. These data are the kind of information that policy-makers need in designing new economic and social policies, the researchers believe. The report of their study is published online in the Journal of Health Economics.[1]

So the heck with all that stuff about allowing the “pursuit of happiness”: just control blood pressure, and voila, everyone is happy.

Well, not exactly. Because the studies didn’t examine blood pressure, but asked the question:

Among the questions on this survey was: “Would you say that you have had problems of high blood pressure?”

Possible answers were: Not at all / No more than usual / Rather more than usual / Much more than usual. (It was presumed that anyone who replied that they had hypertension must have obtained that information from their physicians.)

The silly part in all of this is that the economists assume that this will give an “objective” measurement for governments that is free of cultural bias.

My dear husband would probably answer “no more than usual” if asked if he had problems of high blood pressure.

He’s had two strokes from severe hypertension, but as long as he takes his pills, it’s “behala na”, the Philippine version of “whatever will be will be”or “what, me worry?”

In contrast, my aged mother and her friends who had their blood pressure taken weekly at the Elderly Center kept their low salt low fat low cholesterol diet as if they were Catholics afraid of committing a venial sin.

So there is a large cultural bias in these things.

Similarly, the question on happiness was:

The question about well-being in the survey was simple: “Would you say you are very satisfied, fairly satisfied, not very satisfied, or not at all satisfied with the life you lead?”… Denmark emerged as the happiest country and Greece, Italy, Portugal, and East Germany ranked lowest.

But why do Germans have such a high level of unhappiness and high blood pressure in the study, while those in genetically related Scandanavia did not? Why the low happiness in countries like Greece and Italy, which used to be known for their happiness?

Then we have this article from Nature:

Depression and negative emotions seem to worsen cardiac health, whereas a good laugh might improve blood vessel function…

Over the past 15 years, researchers have also shown that depression, anxiety and loneliness are linked to inflammation—an important factor in heart disease. At the molecular level, this connection can be traced back to cytokines—proteins produced by immune cells that invoke an inflammatory response. Researchers have found levels of certain cytokines are much higher in people experiencing distress, grief, depression and other difficult emotions10, 11.

So, O.K.

Don’t worry…be happy.

Then there is the depression/Diabetes link.

We docs have known for years that our patients with poorly controlled Diabetes often meet the criteria for clinical depression: Tired all the time, weight loss or gain, lack of pleasure in life. This is serious, because the feeling lousy (clinical depression) is a major reason that many Diabetics can’t work. So some studies suggest that we treat diabetics with anti depressants, to increase the energy level and people who feel better will take their medicines better.

Whoops. This study shows people taking anti depressants have a higher rate of diabetes. Is it the medicine causing the depression? Personally, I doubt it, since GP’s have lots of depressed diabetics but don’t give them pills. If we gave Prozac to everyone we see with mild depression, half our patients would be on the pill…

But it does bring up a question: Were they so badly depressed because of a genetic problem that also was involved in them developing Diabetes, AKA Metabolic syndrome?

Photo from Univ Penn Health System.

The bad news is that if you look like this, your father and mother probably did too…so how much can be blamed on McDonalds, and how much on genes?

Well, studies comparing Pima Indians in the US with their thin Mexican relatives who ate a more traditional diet suggests a lot of the high rate of diabetes and metabolic syndrome is due to lack of exercize and the high fat American diet.

On the other hand, an Irish Brother study showed the Irish brother who ate lots of lard and cheese (but worked hard in the fields) had less heart disease than his slimmer brother in Boston.

See how complicated it gets?

A research study in Scotland suggests suggests about fifty percent of depression is due to genes (about half the problem is due to environment).

That sounds about right, and may be why pills may not work…I mean, give a menopausal depressed lady Prozac, and it won’t solve depression if her real problem is an alcoholic abusive husband. Or did she marry an alcoholic abusive husband because her father was like that, or because she was depressed to begin with and felt his abuse was “true”? Calling Dr. Freud…some of these cases are not quite as simple as they look.

Which brings us back to the high blood pressure part.

Alcohol abuse can raise blood pressure. Stress can raise blood pressure. Diabetes can raise high blood pressure. Social problems can raise high blood pressure. Genes can cause high blood pressure. And diet can raise high blood pressure.

So why are the Germans unhappy with high blood pressure, but their genetically related Swedes don’t?

Or is it because some high blood pressure medicines cause depression? Beta Blockers, which are used for labile hypertension (Blood pressure that goes up with stress) can make people depressed, as can other blood pressure medicines. And a lot of blood pressure medicines make men impotent, which can cause a lot of men to be sad.

Finally, all those happiness studies are being done in the West.

Here in Asia, high blood pressure is a major problem, and felt to be due to all that soy sauce and other condiments in the diet.

An Asian would say: Yes, there is a problem, but we will calm ourselves and meditate and put it in God’s hands. But then, the aim of life is not personal happiness but doing one’s duty in life, which leads to contentment.

The Western approach is somewhat different.

Given personality and happiness are highly dependent on genetics, could a bit of genetic tinkering make us happier? It’s not that simple, says Weiss. Many genes are involved in personality and single genes could have multiple effects so it would be difficult to modify them in a predictable way.

In the East, we see suffering as a way to wisdom.

In the west, we see a problem and fix it.


Nancy Reyes is a retired physician living in the rural Philippines. Her website is Finest Kind Clinic and Fishmarket, and she writes about medicine at HeyDoc Xanga Blog.

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