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Psychological Variables in Hypertension: Relationship to Casual or Ambulatory Blood Pressure in Men

From the Department of Psychiatry and Behavioral Science, State University of New York at Stony Brook (R.F., J.E.S.), Stony Brook; and the Hypertension Center, New York Presbyterian Hospital–Weill Medical College of Cornell University (J.E.S., P.L.S., P.A.L., C.P., W.G., T.G.P.) Ithaca, New York.

Address reprint requests to: Joseph E. Schwartz, Department of Psychiatry, Putnam Hall, South Campus, SUNY at Stony Brook, Stony Brook, NY 11794-8790. Email: jschwartz{at}mail.psychiatry.sunysb.edu

OBJECTIVE: The evidence linking hypertension with personality or psychological characteristics, such as anger, anxiety, or depression, remains equivocal. This may be due in part to limitations of personality theory, confounding by awareness of hypertension, and/or inherent difficulties in measuring blood pressure. This study was designed to investigate the association between mild hypertension as defined by both ambulatory and casual (clinic) blood pressure measurements and various measures of personality and psychological 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 controlling for age, race/ethnicity, and body mass index.

RESULTS: We found no consistent difference between participants with mild hypertension and those with normal blood pressure on any of the psychological variables assessed, including Type A behavior pattern, state and trait anger, anger expression, anxiety, symptoms of psychological distress, locus of control, or attributional style. Results were not due to the use of antihypertensive medication by some of the participants with hypertension nor to the dichotomization of blood pressure into those with and without mild hypertension. This contrasts with previous findings from this study showing a sizable association of ambulatory blood pressure and hypertension with job strain (a situational measure), age, and body mass index.

CONCLUSIONS: These null results suggest that situational, biological, and perhaps behavioral factors are the primary determinants of mild hypertension and that the predictive significance of psychological or dispositional factors is low or negligible in those without overt cardiovascular disease.

Key Words: hypertension • blood pressure • personality • psychological factors.

Abbreviations: ASQ = Attributional Style Questionnaire; BMI = body mass index; JAS = Jenkins Activity Survey; SCL-90-R = Symptom Checklist 90-Revised; STAI = State-Trait Anger Inventory.

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