Association between caregiving duration and hypertension among family caregivers: the TMM CommCohort study

Q: What are the key findings of this study?

Providing family care almost all day was associated with a significantly higher prevalence of morning hypertension (PR 1.26) and evening hypertension (PR 1.27) compared to non-caregivers.

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Hypertension / Family caregiving (n=13518). Intervention: Caregiving almost all day vs. Non-caregivers. Primary outcome: Morning home hypertension (systolic BP ≥135 mmHg, diastolic BP ≥85 mmHg, or antihypertensive medication use) (PR 1.26, 95% CI 1.07-1.48).

Q: What does this research mean for the field?

Providing care almost all day is associated with an increased prevalence of morning and evening home hypertension, especially in caregivers younger than 65 years, though this risk is not captured by clinic blood pressure measurements. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Rieko Hatanaka; Naoki Nakaya; Michihiro Satoh; Kumi Nakaya; Mana Kogure; Ippei Chiba; Sayuri Tokioka; Masato Takase; Taku Obara; Satoshi Nagaie; Takahisa Murakami; Hirohito Metoki; Yohei Hamanaka; Masatsugu Orui; Prof. Eiichi N. Kodama; Nobuo Fuse; Yoko Izumi; Shinichi Kuriyama; Atsushi Hozawa

doi:10.1038/s41440-026-02848-6

Key result

Full-time family caregiving is linked to ~26% higher prevalence of morning hypertension.

PR 1.26
95% CI 1.07-1.48
n=13,518

Why the study?

The physical and psychosocial burdens of prolonged caregiving and their association with hypertension prevalence among family caregivers were unclear.

Does prolonged family caregiving duration increase the prevalence of hypertension in community-dwelling adults?

Key Points

To examine the association between daily caregiving duration and hypertension using morning home blood pressure, evening home blood pressure, and clinic research blood pressure measurements.
Cross-sectional analysis of 13,518 participants from the Tohoku Medical Megabank Community-Based Cohort Study (TMM CommCohort study).
Caregiving time was categorized by questionnaire, and hypertension was defined using Japanese Society of Hypertension 2025 criteria (home BP ≥135/85 mmHg, research BP ≥140/90 mmHg, or medication use).
Prevalence ratios were estimated using multivariable robust Poisson regression adjusted for demographic, lifestyle, clinical, and socioeconomic factors.
Participants caregiving 'almost all day' had significantly higher prevalence ratios of morning hypertension (PR: 1.26; 95% CI: 1.07–1.48; rate: 47.2% vs 37.7%) and evening hypertension (PR: 1.27; 95% CI: 1.03–1.56; rate: 33.3% vs 25.3%) compared to non-caregivers.
Associations were pronounced in caregivers under 65 years old (P for interaction = 0.0031 for morning hypertension; PR: 1.75; 95% CI: 1.32–2.32 in the 'almost all day' group).

Study Design

Type

Cross-Sectional (n=13,518)

Multicenter

Yes

Structured PICO

Does prolonged family caregiving duration increase the prevalence of hypertension in community-dwelling adults?

P

Population

13,518 community-dwelling adults in Japan, including family caregivers and non-caregivers, evaluated cross-sectionally to determine the association between caregiving duration and hypertension prevalence.

E

Exposure

Family caregiving duration, categorized via self-administered questionnaire into four levels: 'almost all day', 'about half a day', '2-3 h a day', and 'only when necessary'.

C

Comparator

Non-caregivers (participants who reported not providing care).

O

Outcome

Hypertension, defined by morning home blood pressure (≥135/85 mmHg or medication), evening home blood pressure (≥135/85 mmHg or medication), and research blood pressure (≥140/90 mmHg or medication) according to the Japanese Society of Hypertension Guidelines 2025.surrogate

Main Result

Relative Risk: 1.26 (95% CI 1.07–1.48)

Absolute Event Rate: 47.2% vs 37.7%

Intensive family caregiving is associated with a significantly higher prevalence of masked morning and evening hypertension, particularly in individuals under 65, emphasizing the need for out-of-office blood pressure monitoring in this population.

Limitations

Cross-sectional design precludes causal inference between caregiving duration and hypertension.
A substantial number of participants were excluded due to missing or insufficient home blood pressure data, potentially introducing selection bias.
Differences in baseline health status could have determined whether an individual assumed a caregiving role (reverse causality).

Implication

Intensive caregiving was associated with higher home hypertension prevalence; leaves open a role for stress in masked hypertension, especially younger adults.

Abstract

With the global increase in elderly individuals requiring long-term care, family caregivers face significant physical and psychosocial burdens. This study examined the association between caregiving duration and hypertension using three indices: morning and evening home blood pressure (HBP) and research blood pressure (BP). This cross-sectional study included 13,518 participants from the Tohoku Medical Megabank Community-Based Cohort Study. Caregiving time was categorized via questionnaire. Hypertension was defined according to the Japanese Society of Hypertension Guidelines for the Management of Elevated Blood Pressure and Hypertension 2025 (HBP ≥ 135/85 mmHg, research BP ≥ 140/90 mmHg, or medication use). Multivariable robust Poisson regression estimated prevalence ratios (PRs), adjusted for demographics, lifestyle and social psychological factors. Participants providing care “almost all day” had significantly higher PRs for morning (PR: 1.26; 95% CI: 1.07–1.48) and evening hypertension (PR: 1.27; 95% CI: 1.03–1.56) than non-caregivers. Notably, no significant association was observed with research BP-defined hypertension. Stratified analyses revealed that these associations were particularly prominent among caregivers aged <65 years ( P -interaction for morning hypertension = 0.003). The interaction between sex and caregiving time was not significant. Prolonged caregiving burden is associated with a higher prevalence of hypertension in the morning and evening, particularly among working-age caregivers. Because these risks were not captured by research BP, HBP monitoring is essential for cardiovascular risk management in caregivers. Social policies and clinical interventions should target younger caregivers to mitigate the physiological strain of 24-h caregiving responsibilities.

Discussion

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Cite This Study

Hatanaka et al. (2026) conducted a cross-sectional in Hypertension / Family caregiving (n=13,518). Caregiving almost all day vs. Non-caregivers was evaluated on Morning home hypertension (systolic BP ≥135 mmHg, diastolic BP ≥85 mmHg, or antihypertensive medication use) (PR 1.26, 95% CI 1.07-1.48). Providing family care almost all day was associated with a significantly higher prevalence of morning hypertension (PR 1.26) and evening hypertension (PR 1.27) compared to non-caregivers.

synapsesocial.com/papers/6acfd7eacc9784cabb8f8e2c https://doi.org/10.1038/s41440-026-02848-6

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Association between caregiving duration and hypertension among family caregivers: the TMM CommCohort study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Association between caregiving duration and hypertension among family caregivers: the TMM CommCohort study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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