Type A, Race, Anger, Forgiveness, Plus Stroke, HRT, and Hydralazine - The Bad, the Good, and the To-Be-Avoided

November 14, 2003

In This Article


This month's Hypertension Highlights concentrates on emotional issues, with recent studies focusing on the positive and negative effects of psychosocial factors on blood pressure, including personality traits and socioeconomic background status. In addition, debate continues about whether blood pressure should be lowered in the setting of acute stroke, the risks associated with HRT in hypertensive women, and the true benefits of the use of hydralazine in pregnant women with severe hypertension.

Several recent studies show the negative effects of psychosocial factors on blood pressure. One study reported that 2 components of the type A personality (time urgency/impatience and hostility) were associated with a nearly 2-fold increase in hypertension incidence in a large population of young adults. The other study recorded the effects of racism and suppression of the resultant anger on blood pressure in African-Americans. Another US study appears to indicate that if anger at an offender can be assuaged by forgiveness, considerable blood pressure benefit can be gained by the person who does the forgiving (no effect on the offender is mentioned).

Risk factors at the start of life have been addressed in a UK study that has shown the long-term effects of birth weight and socioeconomic background at birth on blood pressure in later life. Low birth weight and manual social class appeared to have a negative effect, although the increasing effect of socioeconomic class on blood pressure with age was largely accounted for by an increase in body weight.

A low socioeconomic urban population has been targeted in a National Institutes of Health-sponsored clinical trial of hypertension care and control in African-American men. In this study, a comprehensive intervention conducted at the community level by a multidisciplinary healthcare team resulted in 44% of the men achieving blood pressure control. This is the first such study to be carried out in this underserved population, the researchers believe.

The debate continues about whether blood pressure should be lowered in the setting of acute stroke. Further data in support of current guidelines that it should be avoided whenever possible come from a Brazilian study of patients admitted to hospital within 24 hours of onset of an ischemic stroke. A Danish study has reported an increased risk of stroke in hypertensive, but not normotensive, women taking hormone replacement therapy (HRT); prompting them to suggest that HRT should be avoided in hypertensive women.

Finally, for treatment of severe hypertension in pregnancy, which is potentially dangerous for the fetus as well as for the mother (preeclampsia), the first-choice antihypertensive agent has traditionally been hydralazine. This has now been challenged by Canadian researchers, who have shown in a meta-analysis that hydralazine was associated with poorer maternal and perinatal outcomes as well as being more poorly tolerated than other antihypertensives.


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