Psychosomatic Medicine 13:147-159 (1951)
© 1951 American Psychosomatic Society

Psychologic Mechanisms in Malignant Hypertension

¹ Departments of Psychiatry and Internal Medicine, University of Cincinnati, College of Medicine

In 12 representative patients with malignant hypertension in whom adequate study has been possible, we have found close chronologic correlations between the precipitation of malignant hypertension and the occurrence of emotionally charged life situations. It is felt that the data point toward the existence of a meaningful and understandable system of interrelated forces underlying these chronologic correlations. In the individual case, the precipitating events can be related to specific dynamic constellations in the patient's total personality. Further, these same constellations may in the individual patient be linked with the events associated with the onset of benign hypertension, fluctuations in blood pressure, and exacerbations of the clinical course. It should be emphasized that these correlations are specific within the individual patient. The data do not reveal any specificity of personality structure or conflict situations for the group as a whole and thus do not explain the selection of this organ system. The findings are consistent with the view that the specific choice of the hypertensive vascular mechanism may be related to an additional factor, or factors, such as the presence of a predisposing renal lesion in patients with coexistent renal disease, but as yet unknown in the patients with essential hypertension.

In 6 of 7 patients who had not yet developed renal failure, the course after hospitalization reverted without specific treatment to the benign phase, indicating that spontaneous remission may frequently occur in the early stage of malignant hypertension.