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

Type A Personality Traits Associated With Higher Risk of Hypertension

Evidence of the associations, or negative associations, between psychosocial factors such as type A behavior pattern and therisk of hypertension has been inconsistent. Now US researchers have shown that 2 key components of the type A behavior pattern, time urgency/impatience (TUI) and hostility, during young adulthood are associated with a higher long-term risk of developing hypertension. The results of this study were published in the October 23/29 issue of JAMA.[1]

To determine the risk of hypertension associated with a type A behavior pattern, Lijing L Yan, PhD, MPH (Northwestern University, Chicago, Illinois) and colleagues used data from the National Heart, Lung and Blood Institute's Coronary Artery Risk Development in Young Adults (CARDIA) study, a population-based, prospective study that involved 3308 black and white adults aged 18-30 years recruited during 1985-1986.

At follow-up during 2000-2001, which included blood pressure measurements and self-administered psychological questionnaires, 15% of all participants had hypertension (SBP ≥ 140 mm Hg, DBP ≥ 90 mm Hg, or use of antihypertensive medication) by 33-45 years of age.

On the basis of the psychological questionnaires, 5 psychosocial factors were assessed: TUI, hostility, and achievement striving/competitiveness (all type A behavior components) at the start of the study and depression and anxiety 5 years later. Only TUI and hostility were found to be associated with increased 15-year risk ofhypertension.

On a scale of 0 to 3-4, with higher score indicating the most intense degree of behavior, participants with scores of 3-4 had an 84% higher risk of developing hypertension and those with a score of 2 had a 46% greater risk compared with participants with a score of 0. Hostility was rated on a scale of 0-50 and categorized as quartiles. People in the highest quartile had an 84% higher risk of hypertension and those in the second highest quartile a 38% higher risk compared with those in the lowest quartile. These associations were independent of age, gender, race, baseline SBP, education, body mass index (BMI), daily alcohol consumption, and level of physical activity.

Dr. Yan and coauthors point out that the physiologic processes involved in the linkage between psychosocial factors and the development of hypertension are not well understood, and they call for more rigorous studies on the underlying pathophysiologic mechanisms of health risks related to psychosocial factors.

In an accompanying editorial,[2] Redford B Williams, MD, and John C Barefoot, PhD, Duke University Medical Center (Durham, North Carolina) and Neil Schneiderman, PhD, University of Miami (Miami, Florida) note that psychosocial risk factors such as TUI and hostility do not, by themselves, have any direct effects on disease processes, but affect them via 2 biobehavioral pathways: (1) unhealthy behavior such as smoking, increased caloric intake, and increased alcohol intake; and (2) biologic characteristics such as increased cardiovascular/neuroendocrine reactivity to stress, increased platelet activation, increased anti-inflammatory cytokines, and increased expression of the metabolic syndrome in nondiabetic individuals.

No single biobehavioral pathway is involved in the way psychosocial factors influence the development and course of cardiovascular and other major diseases, the researchers contend. They also point to the role of gene-environment interactions that foster clustering of behavioral, psychological, and biological characteristics and increase the risk of cardiovascular disease. However, it is not necessary to fully understand these interactions before developing ways to ameliorate their impact, they believe. They cite several successful trials of behavioral approaches for secondary prevention in patients with cardiovascular disease[3,4] and pharmacologic interventions targeting depression in coronary heart disease patients.[5,6]

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