Study Finds Hostility, Impatience Increase Hypertension Risk
Impatience and hostility -- two hallmarks of the "type A" behavior pattern -- increase young adults' long-term risk of developing high blood pressure, according to a study in the Journal of the American Medical Association.
Researchers also found that as impatience and hostility increased, so did the risk of high blood pressure. However, other psychological and social factors, such as competitiveness, depression, and anxiety did not increase hypertension risk.
Renal hypertension, also called renovascular hypertension, is elevated blood pressure caused by kidney disease. It can usually be controlled by blood pressure drugs. Some people with renal hypertension can be helped by angioplasty, stenting, or surgery on the blood vessels of the kidney.
The research was conducted by scientists at the Northwestern University Feinberg School of Medicine in Chicago, the University of Pittsburgh in PA, the University of Alabama at Birmingham, and the Birmingham Veterans Affairs Medical Center.
This was the first prospective study to examine, as a group, the effects of key type A behaviors, depression, and anxiety on the long-term risk for high blood pressure. Earlier studies had mostly looked at individual psychological and social behaviors and found conflicting results.
High blood pressure, also known as hypertension, is a major risk factor for heart disease, kidney disease, and congestive heart failure, and is the chief risk factor for stroke. Normal blood pressure is a systolic (top number) of less than 120 millimeters of mercury (mm Hg) and a diastolic (bottom number) of less than 80 mm Hg; high blood pressure is a systolic of 140 mm Hg or higher, or a diastolic of 90 mm Hg or higher. Numbers in between are referred to as "pre-hypertension" and are associated with an intermediate risk of complications related to high blood pressure.
About 50 million Americans -- one in four adults -- have high blood pressure and prevalence increases sharply with age: The condition affects about 3% of those ages 18-24 and about 70% of those 75 and older.
"Although high blood pressure is less common among young adults, young adulthood and early middle age is a critical period for the development of hypertension and other risk factors for heart disease," said lead author Dr. Lijing L. Yan, Research Assistant Professor of Preventive Medicine at Northwestern University. "Previous research on young adults is limited, and our study helps to fill that gap."
The study used data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, which involved 3,308 black and white men and women from four metropolitan areas (Birmingham, AL, Chicago, IL, Minneapolis, MN, and Oakland, CA). The participants were aged 18-30 at the time of their enrollment in the ongoing study.
Participants had periodic physical exams, which included blood pressure measurements and self-administered psycho-social questionnaires. Fifteen percent of all the participants had developed high blood pressure by ages 33-45.
Five psychological/social factors were assessed: time urgency/impatience, achievement striving/competitiveness, hostility, depression, and anxiety. The first three are key components of the type A behavior pattern and were assessed at the start of the study; the other two behaviors were assessed five years later. The factors were assessed by different scales based on the psychosocial instrument used but, in every case, a higher score meant the most intense degree of the behavior.