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Pushy People Push Up Their Blood Pressure

Hostility, impatience linked to risk factor in type A young adults

TUESDAY, Oct. 21, 2003 (HealthDayNews) -- Angry, impatient young men and women are more likely to develop high blood pressure and thus increase their risk of heart attack and stroke, a decades-long study finds.

Experts say it's a fascinating finding, but not one that is going to change the current recommendations for preventing cardiovascular disease.

The study, done by researchers at the Northwestern University Feinberg School of Medicine, reinforces the belief that people with type A personalities and those who are depressed and have constant anxiety run a higher risk of cardiovascular disease than more placid individuals.

This study, reported in the Oct. 22/29 issue of the Journal of the American Medical Association, looked at the relationship between such psychosocial traits and high blood pressure, a well-known risk factor for heart disease and stroke.>

The researchers followed more than 3,300 young adults (18 to 30 years old) from 1986 to 2001, measuring three main components of type A behavior -- hostility, impatience and competitiveness -- as well as depression and anxiety.

Two type A traits, hostility and impatience, "were associated in a dose-response manner with a higher risk of developing hypertension [high blood pressure] 15 years later," says the journal report. "Those associations were independent of age, sex, race, baseline systolic blood pressure, body mass index, daily alcohol consumption and level of physical activity."

The most hostile and impatient people were 1.8 times more likely to develop hypertension than those who scored the lowest on both fronts, the study found.

Competitiveness, anxiety and depression were associated with high blood pressure only for white men, the study finds.

One indication that behavior modification isn't likely to be part of ordinary medical practice is the report's statement that what is needed now is "the development of effective strategies for recognizing, modifying, alleviating and managing harmful psychosocial tendencies."

"We're not at that stage yet," says Dr. Redford B. Williams, a professor of psychiatry and medicine at Duke University Medical Center and co-author of an accompanying editorial. "We are on the right track at looking at these types of psychosocial factors, and this kind of study offers a further guide to what should be our target."

"But I am the first to admit that we are nowhere close to having the knowledge base about changing behavior as in changing cholesterol levels."

"Many more studies must be done and many more people studied before behavioral treatment becomes the standard of care for patients with heart disease," adds Dr. Leslie Cho, director of the cardiology intervention program at Loyola University Health System in Maywood, Ill. "Treating patients by modifying behavior is still far from becoming a reality."

Self-awareness is the way many people can use the finding to help themselves, Cho says. "People can tell if they are angry and agitated, unless they are in denial," she says. "They can do simple things like stopping smoking, watching what they eat, exercising more -- good, common-sense things."

Behavioral treatment may well enter general practice because people with risk-increasing personality traits are more likely to smoke, have high cholesterol levels and have high blood pressure, Williams says.

"It's hard to get people to stop smoking or change dietary habits without addressing an underlying cause, such as behavior," Williams says.

His assessment of the time and effort needed to reach that goal is based on the history of beta blockers, drugs that are now commonly used to treat high blood pressure.

"Maybe where we are in psychosocial studies is where we were with beta blockers 30 years ago," Williams says. "Then we had some studies saying they provided a benefit and others saying they did not. It took studies involving 20,000 to 30,000 people to show a pretty reliable reduction in risk."

More information

A rundown of known risk factors for heart disease can be found at the American Heart Association. Learn about the type A personality from its discoverer, Dr. Meyer Friedman.

SOURCES: Leslie Cho, M.D., director, cardiology intervention program, Loyola University Health System, Maywood, Ill.; Redford B. Williams, professor, psychiatry and medicine, Duke University Medical Center, Durham, N.C.; Oct. 22/29, 2003, Journal of the American Medical Association
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