Psychosocial Factors Predict Hypertension and Coronary Heart Disease

October 2, 2007 —- Trait anger in middle-aged men and long-term stress in men and women predicted the progression from prehypertension to hypertension and incident coronary heart disease (CHD); exercise may reduce trait anger, according to the results of the Atherosclerosis Risk in Communities (ARIC) trial reported in the September/October issue of the Annals of Family Medicine.
"Patients with prehypertension are more likely to progress to frank hypertension," write Marty S. Player, MD, from the Medical University of South Carolina in Charleston, and colleagues. "The role of various psychosocial factors in cardiovascular disease has been of interest for many years.... The objective of this study was to investigate whether psychosocial factors are associated with progression from prehypertension to hypertension and to CHD or CHD mortality after adjustments for traditional risk factors."
The investigators performed a secondary analysis of the ARIC cohort of men and women aged 45 to 64 years at enrollment, including 2334 participants who had prehypertension at the second visit conducted between 1990 and 1992, who had no heart disease or stroke at baseline and who were observed from 1996 to 1998 when the ARIC study was completed. The primary endpoints were progression from prehypertension to hypertension and prehypertension to CHD or death from CHD.
Compared with low to moderate levels of trait anger measured by the Spielberger Trait Anger Scale, high levels were associated with progression from prehypertension to hypertension (adjusted odds ratio [OR], 1.53; 95% confidence interval [CI], 1.05 - 2.24). Analysis by sex revealed that trait anger was predictive for men but not for women (OR, 1.71; 95% CI, 1.04 - 2.83), and that trait anger in men was associated with progression to CHD, based on survival analysis (hazard ratio [HR], 1.92; 95% CI, 1.07 - 3.54). In both sexes, long-term psychological stress on the Maastricht Questionnaire was associated with risk for incident CHD(HR, 1.68; 95% CI, 1.18 - 2.40).
"High levels of trait anger in middle-aged prehypertensive men were associated with increased risk of progressing to hypertension and incident CHD," the study authors write. "Long-term stress was also associated with increased risk of incident CHD in both men and women."
Limitations of the study include lack of generalizability to patient populations of different ages, observational design precluding causal inference, low incidence (5.8%) of CHD in women in this cohort, and limited duration of follow-up.
"The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure designated prehypertension as a new blood pressure category based on the increased cardiovascular risks and events associated with blood pressures in this range," the study authors conclude. "The findings of this study further support these associations with prehypertension. Additionally, we were able to show that beyond traditional cardiovascular risk factors, anger and psychological stress play a role in development of CHD in participants with prehypertension."
The Health Resources and Services Administration and the National Heart, Lung, and Blood Institute supported this study. The study authors have disclosed no relevant financial relationships.
Ann Fam Med. 2007;5:403-411.