ANGER EXPRESSION AND INCIDENT HYPERTENSION

Objective: It has long been thought that anger is important in the dev elopment of essential hypertension. However, tests of this hypothesis have yielded conflicting findings. This study prospectively examined t he relationship between anger expression style and incident hypertensi on in a population sample of middle-aged men. Methods: Participants we re 537 initially normotensive men from eastern Finland, who completed a medical examination and series of psychological questionnaires at ba seline and at 4-year follow-up. Anger expression was assessed by Spiel berger's Anger-out and Anger-in scales. Results: At follow-up, 104 men (19.4%) were hypertensive (blood pressure greater than or equal to 16 5 mm Hg systolic and/or 95 mm Hg diastolic). Age adjusted logistic reg ression analyses revealed that each 1-point increase in Anger-out was associated with a 12% increase in risk of hypertension after 4 years o f follow-up (p < .002), which corresponded to a two-fold increased ris k of hypertension among men with scores in the top tertile of the Ange r-out scale, relative to those with scores in the bottom tertile (odds ratio = 2.00, 95% confidence interval 1.20-3.38). Each 1-point increa se on the Anger-in scale also was related to a 12% increased risk of h ypertension (p < .01). Adjustments for body mass index, smoking, alcoh ol consumption, physical activity, a positive parental history of hype rtension, and baseline resting diastolic blood pressure had Little imp act on the findings. Conclusions: These data provide strong epidemiolo gical evidence for a positive relationship between anger expression st yle and subsequent hypertension, independent of known risk factors. Fi ndings support the hypothesis that extreme expression of anger in eith er direction has adverse cardiovascular consequences.