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

Marty S. Player; Dana E. King; Arch G. Mainous; Mark E. Geesey

doi:10.1370/afm.738

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Figure 1.
CHD event-free survival probabilities among prehypertensive participants by Maastricht Questionnaire scores.
CHD = coronary heart disease.
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Figure 2.
CHD event-free survival probabilities among prehypertensive men by Spielberger Trait Anger Scale scores.
CHD = coronary heart disease.
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Figure 3.
CHD event-free survival probabilities among prehypertensive women by Spielberger Trait Anger Scale scores.
CHD = coronary heart disease.

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Table 1.

Demographics and Bivariate Analysis of Participants With Prehypertension During Visit 2 in the ARIC Study (N = 2,334) and Percentage of Each Group Developing Hypertension and Coronary Heart Disease

		Development of Hypertension		Development of CHD/CHD Death
Variable	Population No. (%)	%	χ²P Value	%	χ²P Value
ARIC = Atherosclerosis Risk in Communities; CHD = coronary heart disease.
Age category			<.001		.014
48–57 y	1,176 (50.4)	53.0		9.6
58–67 y	1,158 (49.5)	63.2		12.9
Sex			<.001		<.001
Male	1,127 (48.3)	53.2		17.0
Female	1,207 (51.7)	62.6		5.8
Race			<.001		.005
Nonblack	1,863 (79.8)	56.0		12.2
Black	471 (20.2)	66.3		7.6
Diabetes			.052		<.001
Yes	117 (5.0)	67.3		24.0
No	2,217 (95.0)	57.5		10.5
Low-density lipoprotein cholesterol			.110		.075
≤160 mg/dL	1,839 (78.8)	57.0		10.5
>160 mg/dL	495 (21.2)	61.4		13.4
Maastricht Questionnaire score			.045		.019
Low (0–7)	773 (33.1)	56.7		10.1
Moderate (8–12)	756 (32.4)	55.1		9.5
High (>12)	805 (34.5)	61.6		13.7
Spielberger Trait Anger Scale score			.018		.011
Low (10–14)	901 (38.6)	59.9		9.8
Moderate (15–21)	1,272 (54.5)	55.6		11.5
High (>21)	161 (6.9)	66.7		18.0
≥2.5	1,351 (57.9)	56.8		10.8
Body mass index			.007		.362
≤30	1,671 (71.6)	56.3		10.8
>30	663 (28.4)	62.8		12.2
Exercise hours per week			.168		.484
<2.5	983 (42.1)	59.8		11.8
≥2.5	1,351 (57.9)	56.8		10.8
Current smoking status			.349		.021
Yes	502 (21.5)	60.0		14.0
No	1,832 (78.5)	57.5		10.4
Lubben Social Network score			.796		.220
Low (0–35)	707 (30.3)	57.7		12.5
Moderate (36–39)	728 (31.2)	57.6		10.0
High (>39)	899 (38.5)	59.7		8.8

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Table 2.

Unadjusted Analysis for Progression to Hypertension or CHD/CHD Death by Psychosocial Category in Prehypertensive Participants

Psychosocial Variable	*Progression to Hypertension OR (95% CI)**	Progression to CHD/CHD Death^†OR (95% CI)
CHD = coronary heart disease; OR = odds ratio; CI = confidence interval.
* Unadjusted simple logistic regressions.
† Unadjusted Cox survival analyses.
Maastricht Questionnaire score (long-term stress)
Low/moderate	1.00	1.00
High	1.26 (1.04–1.52)	1.27 (0.91–1.76)
Spielberger Trait Anger Scale score
Low/moderate	1.00	1.00
High	1.49 (1.03–2.14)	2.14 (1.31–3.49)

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Table 3.

Logistic Regression Modeling for Likelihood of Developing Hypertension in a Population of Prehypertensive Middle-Aged Participants

Psychosocial Variable	*Total AOR (95% CI)**	Men^†AOR (95% CI)	Women^†AOR (95% CI)
AOR = adjusted odds ratio; CI = confidence interval.
* Adjusted for age category, race, sex, body mass index category, low-density lipoprotein cholesterol category, diabetes, and exercise category.
† Adjusted for age category, race, body mass index category, low-density lipoprotein cholesterol category, diabetes, and exercise category.
Maastricht Questionnaire score (long-term stress)
Low/moderate	1.00	1.00	1.00
High	1.06 (0.87–1.30)	1.11 (0.81–1.51)	1.02 (0.79–1.33)
Spielberger Trait Anger Scale score
Low/moderate	1.00	1.00	1.00
High	1.53 (1.05–2.24)	1.71 (1.04–2.83)	1.34 (0.76–2.36)

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Table 4.

Cox Regression Modeling for Likelihood of Experiencing a CHD Event or CHD Death in a Population of Prehypertensive Participants Initially Aged 48 to 67 Years

Psychosocial Variable	*Total AHR (95% CI)**	Men^†AHR (95% CI)	Women^†AHR (95% CI)
AHR = adjusted hazard ratio; CHD = coronary heart disease; CI = confidence interval.
* Adjusted for age category, sex, race, smoking status, low-density lipoprotein cholesterol category.
† Adjusted for age category, race, smoking status, low-density lipoprotein cholesterol category.
Maastricht Questionnaire score (long-term stress)
Low/moderate	1.00	1.00	1.00
High	1.68 (1.18–2.40)	1.54 (1.03–2.28)	2.63 (1.04–6.68)
Spielberger Trait Anger Scale score
Low/moderate	1.00	1.00	1.00
High	1.71 (0.99–2.93)	1.92 (1.07–3.45)	0.95 (0.20–4.51)

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The Article in Brief

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

Marty S. Player, MD , and colleagues

Background There is increasing evidence that people with prehypertension (systolic blood pressure of 120 to 139 mm Hg and diastolic blood pressure of 80 to 89 mm Hg) are at greater risk for developing high blood pressure or cardiovascular disease. This study investigates whether psychosocial factors are associated with the progression from prehypertension to hypertension and prehypertension to heart disease.

What This Study Found Middle-aged men with prehypertension who have high levels of trait anger (a tendency to experience anger across a range of situations) have a higher risk of developing hypertension and coronary heart disease. Men with high trait anger scores have 1.7 times greater odds for developing hypertension than those with low or moderate scores, and high trait anger scores are associated with a 90 percent increase in the risk of progression to coronary heart disease in prehypertensive men. Long-term stress is associated with greater risk of coronary heart disease in both women and men.

Implications

This study suggests that anger and psychological stress play a role in developing heart disease in individuals with prehypertension.
Further research is needed to determine whether treating anger and psychological stress helps slow the progression of prehypertension to hypertension and coronary heart disease.