Most of us think of emotional expression as something rooted in psychology—our thoughts, our feelings, our personality. But emerging research continues to remind us that the body and mind are tightly intertwined.
A new study, published in Frontiers in Psychiatry, offers compelling evidence that elevated blood pressure may actually mute our ability to express certain emotions on the face.
This work extends a growing line of research on Cardiovascular Emotional Dampening (CED). Previous studies have shown that individuals with higher blood pressure often struggle to recognize emotions in others.
But recognition is only half of the communication process. The other half—how well we express our own emotions—has received far less attention. Until now.
A First Look at Expression, Not Just Perception
To explore this expressive side of CED, researchers recruited adults across a range of blood pressure levels: normotensive, prehypertensive, and hypertensive.
Participants were asked to deliberately pose six basic emotions—happiness, anger, fear, sadness, disgust, and surprise—while being recorded.
What makes this study especially robust is that the researchers didn’t rely on just one method of evaluation.
Each expression was coded by both trained human raters and an automated facial-analysis system. This dual-approach allowed the team to capture subtle details in facial movement and emotional accuracy.
The results were striking.
High Blood Pressure, Lower Expressive Accuracy
Individuals with higher blood pressure consistently showed reduced accuracy when attempting to portray several negative emotions. Expressions of sadness, fear, and surprise were particularly affected. Their facial movements were often less pronounced, less coordinated, or did not match the emotion they were instructed to express.
Even more interesting, these expressive deficits were correlated with both systolic and diastolic blood pressure levels. In other words, as blood pressure climbed, expressive clarity tended to drop.
But one emotion stood out as the exception: happiness. Smiles, it seems, remained largely intact across blood-pressure groups. Positive facial expressions did not show the same dampening effect.
This asymmetry—preserved positive expressivity alongside muted negative expressivity—matches patterns seen in previous research on perception. People with higher blood pressure tend to have more difficulty recognizing negative emotions too. This new work suggests that the expressive channel may be shaped in a similar way.
Why Blood Pressure Would Affect the Face
At first glance, the idea that blood pressure could influence facial expressions sounds surprising. But the connection makes sense when viewed through the lens of embodiment and autonomic regulation.
Our emotional expressions depend on rapid, flexible coordination between the brain, autonomic nervous system, and facial musculature.
Elevated blood pressure is associated with reduced autonomic flexibility, altered baroreflex functioning, and changes in brain regions tied to emotion.
Together, these physiological shifts may blunt the body’s responsiveness—making expressions less intense or less accurately matched to the intended emotion.
In other words, emotional dampening may reflect a broader bodily pattern, rather than a conscious choice.
Implications for Emotional Communication
For those of us who study or teach nonverbal behavior, these findings highlight an important nuance.
When people express emotions weakly or unclearly, the first impulse may be to attribute meaning: Are they bored? Detached? Concealing something?
But this study suggests a different possibility—some individuals may be genuinely physiologically less expressive in certain emotional domains.
This is especially relevant in high-stakes interpersonal environments:
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clinical interviews
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security screenings
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conflict-resolution settings
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relationship communication
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or any context requiring accurate emotional interpretation.
A muted expression of fear or sadness may reflect cardiovascular state, not emotional withholding.
This does not mean that facial expressions are unreliable. Rather, it underscores the role of individual differences—and why accurate emotion reading requires context, pattern recognition, and caution against over-interpretation.
Where the Research Is Heading
This study opens several important doors for future inquiry.
One question is whether these expressive differences appear in spontaneous emotional behavior, not just posed expressions. Real-world emotional reactions often rely on automatic facial-muscle activation, which may be even more susceptible to physiological influences.
Another question concerns other nonverbal channels. Prior research has shown that emotional dampening linked to elevated blood pressure can affect recognition of vocal and cross-modal cues as well. Whether expressive dampening extends to the voice, gestures, or posture remains to be seen.
Finally, researchers are beginning to wonder whether improving cardiovascular health—through stress reduction, exercise, or medical treatment—might help restore emotional clarity in recognition and expression. If so, the relationship between physiology and emotion may be more dynamic than previously thought.
The Takeaway
This new study adds an important piece to the puzzle of how our bodies shape our emotional world. Elevated blood pressure doesn’t only influence the heart and blood vessels—it may subtly influence the face we show to others.
For clinicians, trainers, and anyone committed to understanding nonverbal behavior, the message is clear: emotional expression is deeply embodied. And sometimes, behind a quiet or muted face, the physiology may be speaking louder than the expression itself.
Commentary from Dr. Matsumoto
There’s much to like about this study. Before I comment about the implications of its findings, however, I would be remiss if I didn’t discuss some questions about the methodology that I have.
First, I’m wondering how they measured accuracy of emotional expressions. Expression accuracy can be measured several different ways and the authors never explained that in detail. That type of detail is important in understanding how to interpret the findings, so I would have wanted more info about that.
Also, the study didn’t require participants to engage in an emotion recognition or perception task. That would have been important because the authors make interpretations about the associations between expressions and perceptions in the Discussion, along with their underlying neural processes. Without actual data about that, however, such interpretations rest on many assumptions and thus become quite speculative.
But let’s give on the methods issues for a moment and consider the implications of the findings, which are interesting and have strong implications for an understanding of the effects of high blood pressure on the neural pathways controlling facial expressions.
More generally, the findings raise questions about how other psychophysiological states impact expression and recognition, and why. Do these findings generalize to stress, neuropathies, or other medical conditions? And what do such effects mean about how humans are wired together, a question that we have so much left to explore.
All in all the study is quite thought provoking and should inspire more research like it in the future, integrating emotion, health, and neuropsychological topics.
Given the dismantling of Humpty Dumpty into many silos of academia for the past century, hopefully the future can put Humpty Dumpty back together again.