Personality differences between hypertensive and normotensive individuals: influence of knowledge of hypertension status.

Abstract

Personality characteristics such as anxiety and anger have long been associated with essential hypertension, but the results of past studies have often been confounded by inadequate diagnosis of hypertension, antihypertensive medications, and use of unvalidated measures of personality. Moreover, little attention has been given to the importance of differential exposure to medical attention and labeling as determinants of personality. To overcome these shortcomings, personality characteristics were measured by self-report using validated questionnaires in untreated male and female hypertensives who were either aware (n = 80) or unaware (n = 82) of their hypertension at the time of assessment. Hypertension diagnosis was based upon repeated blood pressure measurements over 5 months. Hypertensives were compared to age-, sex-, ethnicity-, and occupation-matched normotensives. Results indicated that aware hypertensives scored significantly higher than normotensives and unaware hypertensives on neuroticism, trait and state anxiety, and self-reported Type A behavior. They also scored higher than normotensives on state anger, and there was a similar trend for anger suppression. There were no differences between unaware hypertensives and normotensives. The findings suggest that these personality factors are not a fundamental characteristic of hypertension but reflect the influence of exposure to medical attention or knowledge of hypertension status.

Differences in emotional personality traits and stress between sustained hypertension and normotension

“…[32][33][34] Thus, the positive associations of trait depression and trait anxiety with hypertension may reflect the negative psychological effects of being diagnosed or labeled as hypertensive or, alternatively, a selection bias, as individuals who tend to experience negative affect are more likely to visit physicians and, therefore, could be more likely to have their BP measured and to be diagnosed as having hypertension.…”

“…First, most of the studies have only considered clinic BP measures and, therefore, were not able to detect and control the potential presence of participants with isolated clinic hypertension. Second, most of the studies did not measure personality characteristics (see Irvine et al's study 32 for an exception); rather, they assessed emotional symptoms or perceived psychological well-being, which, unlike measures of personality, are expected to fluctuate. Moreover, there are also studies that have failed to support the idea that labeling persons as hypertensive is necessarily followed by negative psychological consequences, 35 including one with prospective design.…”

Job Strain and Cardiovascular Disease

“…Higher risk of CHD due to job strain was found among older Framingham women (68) (risk ratio = 5.1 for age 55-64 compared to risk ratio = 2.9 for all participants, aged [45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64], and of CVD among older Swedish white-collar men (50) (standardized risk ratio = 1.7 for age> 44 compared to standardized risk ratio = 0.3 for age:::: :; 44). Greater effect sizes also were found for heart disease symptoms among older Swedish white-collar workers (53), and blood pressure among older New York City employees (101).…”

“…Mild hyperten sives did not differ from normotensives on anger, anxiety, hostility, Type A behavior, or other psychological measures in the New York City blood pressure study (100). In most of the positive studies, hypertensives have been aware of their blood pressure and therefore these psychological char acteristics could result from diagnosis and labeling rather than representing etiological factors (46,95). For example, one study found that hypertensives who were aware of their status scored higher than normotensives and unaware hypertensives on neuroticism, anxiety, and Type A behavior (46).…”

“…In most of the positive studies, hypertensives have been aware of their blood pressure and therefore these psychological char acteristics could result from diagnosis and labeling rather than representing etiological factors (46,95). For example, one study found that hypertensives who were aware of their status scored higher than normotensives and unaware hypertensives on neuroticism, anxiety, and Type A behavior (46). The concept of "negative affectivity" or "neuroticism" as a confounder of the stress-psychological strain association has been widely investigated (80).…”