On-the-Job Anger and High Blood Pressure

From the WebMD Archives

March 17, 2000 (Atlanta) -- Everyone gets angry while on the clock. However, effective coping strategies at work might help reduce the risk of high blood pressure, according to a new report in the journal Psychotherapy andPsychosomatics. Experts say an open style is healthier than a covert style, particularly for middle-aged men and women.

Because anger is thought to accelerate the onset of high blood pressure, Swedish researchers explored the relationship between coping and high blood pressure in a large sample of working men and women. Almost 6,000 workers participated, from 15 to 64 years of age in over 150 occupations.

Individual coping patterns were determined by a questionnaire. Open coping was defined as strategies directed toward the aggressor and covert coping was described as strategies directed inward or at uninvolved people. High blood pressure was defined as blood pressure exceeding 160/90 or the use of high blood pressure medication.

Although the incidence of high blood pressure rose with age, there was no difference in smoking habits, alcohol consumption, socioeconomic status, or work environment between those with and without high blood pressure. Also, coping style was not shown to have a relationship with high blood pressure in younger and older workers.

But in middle-aged men and women, those with low scores for open coping had a significantly higher incidence of high blood pressure. Low scores for open coping were also strongly associated with less control in the job. And in general, women reported more frequent use of covert coping strategies than men.

The authors say the data have some important implications. "There appears to be a link between covert coping and [high blood pressure]," says Lars Alfredsson, PhD, a co-author and associate professor of epidemiology at Karolinska Institute in Stockholm, Sweden. "And it appears that work environments with low decision latitude may facilitate covert coping styles."

Alfredsson tells WebMD that coping strategies can be improved. "Angry or upset workers should first calm down. Then they should talk with the aggressor," says Alfredsson. "This open approach is much healthier than holding it in or taking it out on spouses and children."

Psychiatrists say that covert coping should be unlearned. "Over time, anger turned inward can manifest itself as depression," says Renato Alarcon, MD, chief of psychiatric services at the Veterans Affairs Medical Center in Atlanta and professor of psychiatry at Emory University School of Medicine. "It's also associated with [stomach ulcers], pain syndromes, and [lowered ability to fight off infection]."

Alarcon says there are three steps to better coping. "First, look at the circumstances objectively. Then, invite the aggressor for a discussion of possible solutions. Finally, develop a timetable for evaluation of the agreed upon solution," says Alarcon. "These behaviors help to depersonalize the situation and enable us to think more clearly."

Alarcon tells WebMD that some questions remain unanswered, and the researchers agree.

"The question of whether coping style is stable or dynamic was not explored," says Alfredsson. "And this is a critical issue in need of further study." Alfredsson tells WebMD that a follow-up study of the relationship between coping style and heart attack is now underway.