A critical review of the literature pertaining to the role of anger and hostility in essential hypertension and coronary heart disease is presented. Psychodynamic, personality, and psychophysiological approaches are covered. Anger and hostility appear to play an important role in the development of hypertension, though the mechanism is not yet clearly specified. In the coronary heart disease literature, aggression is more commonly referred to than anger; recent evidence suggests, however, that hostility may be a highly significant component of the Type A coronary-prone behavior pattern. The research reviewed is seen as providing support for the utility of emotion as a construct relevant to understanding psychophysiological mechanisms associated with cardiovascular disorders.

We studied 39 nursing home patients and proxies to assess their decision-making capability and preferences regarding advance directives (ADs) or "living wills." Most patients willingly stated preferences; over half opted to forego burdensome measures when death appeared imminent. Patients perceived as decisionally capable were more likely to forego life-sustaining measures than those of questionable capability. The vast majority of proxies disapproved of using life-sustaining measures, even in some cases with limited knowledge of patients' preferences.

Anger/hostility and Type A behavior have been implicated in elevated cardiovascular reactivity and disease. In the present experiment systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were monitored during conditions of competition alone or in conjunction with goal blocking or harassment. Cardiovascular reactivity was examined as a function of conditions, Type A or B pattern, and various measures of anger/hostility. Harassment elicited significantly elevated SBP and HR changes relative to goal-blocking and control conditions. Type As reliably exceeded Type Bs in magnitude of SBP change during the harassment condition only. However, exploratory analyses correlating anger/hostility measures and cardiovascular reactivity indicated that only subjects scoring high on the Buss-Durkee Hostility Inventory showed significantly elevated SBP reactivity as a function of Type A behavior pattern, rated hostility during the A-B interview, or outward expression of anger assessed by the Framingham Anger-In vs Anger-Out Scale.

Self-regulation of diabetes depends in part on common-sense models of symptoms and blood glucose fluctuations. Symptom perception and subjective estimation of blood glucose were studied in 52 adult, difficult-to-control, non-insulin-dependent diabetics using a structured interview and laboratory blood-glucose measurement. Most patients believed they could detect hyperglycemia. Symptoms linked by patients to hyperglycemic and hypoglycemic episodes did overlap with symptoms traditionally associated with those states. Some patients may experience dysphoria during glycemic swings to which multiple symptom labels are applicable, although prominent exceptions and idiosyncratic symptoms were evident. Estimation of current blood glucose using an ordinal scale suggested some capacity for discriminating blood glucose levels. Numerical estimates of Chemstrip values were correlated with actual values, but far too inaccurately for purposes of self-regulation. Research is needed to clarify whether subjective symptom perception and blood glucose estimation helps or hinders self-regulation of diabetes.

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