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A Quantitative Review of Prospective Evidence Linking Psychological Factors With Hypertension Development

From the University of Pittsburgh (T.R.), Pittsburgh, Pensylvania and the University of British Columbia (B.E.H.), Vancouver, BC, Canada.

Address reprint requests to: Thomas Rutledge, VA Medical Center, Psychology Service (116B), 3350 La Jolla Village Drive, San Diego, CA 92161. Email: dr.tom{at}medscape.com

OBJECTIVE: To quantitatively review and critique evidence from prospective cohort studies (greater than 1 year follow-up) assessing associations between psychological factors (eg, anxiety, anger, depression) and hypertension development.

METHODS: Keyword searches through the MEDLINE and Psychlit (1970 to present) databases produced in excess of 500 studies, of which only 10 met criteria as a prospective cohort design with a follow-up interval exceeding 1 year. Five additional longitudinal studies were found by tracing references from the above papers.

RESULTS: The sample-weighted aggregate effect sizes for hypertension risk were small for continuously measured psychological factors (r = .08), and effect sizes were similar for separate categories of psychological variables (r values = .07–.09). Effect sizes were not associated with reported methodological or sample characteristics, including sample size, racial and sex composition, study duration, or age.

CONCLUSIONS: Overall, there is moderate support for psychological factors as predictors of hypertension development, with the strongest support for anger, anxiety, and depression variables. Pooled effects for these factors are of sufficient magnitude to suggest potential clinical as well as statistical relevance. Findings regarding potential mechanisms are scarce and the psychometric properties of the scales used to measure psychological variables are often unestablished. Indications for future research are discussed.

Key Words: hypertension, • blood pressure, • psychological factors, • prospective.

Abbreviations: DBP = diastolic blood pressure;; SBP = systolic blood pressure;; CAD = coronary artery disease;; AMBP = ambulatory blood pressure monitoring.; NHANES = National Health and Nutrition Examination Survey.

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