TUCSON, ARIZ. — High levels of anger and long-term psychological stress are independent predictors that prehypertension will progress to hypertension, coronary artery disease, and coronary artery disease-related death, Dr. Marty Player said at the annual meeting of the North American Primary Care Research Group.
Dr. Player presented a secondary data analysis of the Atherosclerosis Risk in Communities (ARIC) study, a prospective study of 15,792 men and women aged 45–64 years at the time of enrollment in four U.S. communities. The analysis included 2,334 individuals free of cardiovascular disease with blood pressure in the prehypertension range, defined as a systolic BP of 120–139 mm Hg or diastolic BP of 80–89 mm Hg. First examinations were conducted from 1987 to 1989, with annual telephone interviews and three triennial visits through 1998.
Using a bivariate analysis, researchers found that the factors significant for progression from prehypertension to hypertension were advanced age, female gender, and black race, reported Dr. Player, a research fellow, and colleagues in the family medicine department at the Medical University of South Carolina, Charleston. The research was presented as one of the meeting's distinguished papers.
After the researchers adjusted for age, race, body mass index, diabetes mellitus, and exercise, the odds ratio of developing hypertension was 1.53 for any participant having a high score on the Spielberger Trait Anger Scale. High trait anger indicates anger that occurs frequently with high intensity and prolonged duration. The association was significant for men (odds ratio 1.71) but not for women (OR 1.34), he said.
The researchers also evaluated progression to coronary heart disease as indicated by a history of MI, revascularization procedure, MI on electrocardiogram, or fatal coronary heart disease recorded at a triennial visit or annual follow-up interview.
Using a bivariate analysis, researchers found that age, gender, and nonblack race were significant factors for progression of atherosclerosis disease. More men (17%) developed coronary heart disease or fatal CHD, compared with women (5.8%), as did nonblacks (12%), compared with blacks (7.6%).
In a multivariate analysis, high levels of prolonged psychological stress, as assessed by the Maastricht Questionnaire, were significantly associated with progression to CHD and fatal CHD in all participants (OR 1.68). The association was stronger in women (OR 2.63) than in men (OR 1.54). About 10% of patients with a Maastricht Questionnaire score of 7 or less developed CHD or fatal CHD, vs. 9.5% of those with scores of 8–12, and 14% with a score of 12 or more.
High Spielberger anger scores were significant predictors of progression to CHD or fatal CHD in men (OR 1.92) but not in women (OR 0.95), reported the authors, whose work was supported by the U.S. Department of Health and Human Services' Health Resources and Services Administration.
Further research should evaluate common psychosocial variables, such as depression and anxiety, and include younger patients. Behavioral therapy may provide benefit for patients with prehypertension, Dr. Player said.