Psychological variables in hypertension: Relationship to casual or ambulatory blood pressure in men

Objective: The evidence linking hypertension with personality or psychologi cal characteristics, such as anger, anxiety, or depression, remains equivoc al. This may be due in part to limitations of personality theory, confoundi ng by awareness of hypertension, and/or inherent difficulties in measuring blood pressure. This study was designed to investigate the association betw een mild hypertension as defined by both ambulatory and casual (clinic) blo od pressure measurements and various measures of personality and psychologi cal characteristics. Methods: We examined this association in a population- based sample of 283 men between the ages of 30 and 60 years from eight work sites in New York City, using an ambulatory blood pressure monitor and con trolling for age, race/ethnicity, and body mass index. Results: We found no consistent difference between participants with mild hypertension and thos e with normal blood pressure on any of the psychological variables assessed , including Type A behavior pattern, state and trait anger, anger expressio n, anxiety, symptoms of psychological distress, locus of control, or attrib utional style. Results were not due to the use of antihypertensive medicati on by some of the participants with hypertension nor to the dichotomization of blood pressure into those with and without mild hypertension. This cont rasts with previous findings from this study showing a sizable association of ambulatory blood pressure and hypertension with job strain (a situationa l measure), age, and body mass index. Conclusions: These null results sugge st that situational, biological, and perhaps behavioral factors are the pri mary determinants of mild hypertension and that the predictive significance of psychological or dispositional factors is low or negligible in those wi thout overt cardiovascular disease.