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Psychosocial Factors and Progression From Prehypertension to Hypertension or Coronary Heart Disease

Department of Family Medicine, Medical University of South Carolina, Charleston, SC

CORRESPONDING AUTHOR: Marty Player, MD, Department of Family Medicine, Medical University of South Carolina, 295 Calhoun St, Charleston, SC 29425, playerm{at}musc.edu

PURPOSE This study explored the influence of trait anger and long-term psychological stress on progression to hypertension and incident coronary heart disease (CHD) in persons with prehypertension.

METHODS A secondary data analysis was performed using the Atherosclerosis Risk in Communities (ARIC) study, a cohort of men and women aged 45 to 64 years at enrollment. Participants with blood pressures in the prehypertension range at the second visit conducted between 1990 and 1992, free of heart disease or stroke, and observed through the end of the ARIC study (1996–1998) were included (N = 2,334). The main outcomes were progression from prehypertension to hypertension and prehypertension to CHD or CHD death.

RESULTS After adjusting for various covariates, high levels of trait anger, compared with low/moderate levels (odds ratio [OR] 1.53; 95% confidence interval [CI], 1.05–2.24), were associated with progression from prehypertension to hypertension. After stratifying on sex, trait anger was predictive for men only (OR 1.71; 95% CI 1.04–2.83). In survival analysis, trait anger was associated with progression to CHD for men (hazard ratio [HR] 1.92; 95% CI, 1.07–3.54). Long-term psychological stress was also associated with risk of incident CHD (HR 1.68; 95% CI 1.18–2.40).

CONCLUSIONS High levels of trait anger in middle-aged prehypertensive men were associated with increased risk of progressing to hypertension and incident CHD. Long-term stress was also associated with increased risk of incident CHD in both men and women.

Key Words: Prehypertension • psychosocial factors • hypertension • anger • stress, psychological

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