Anger and Hypertension

The causes of chronically elevated blood pressure, formally known as hypertension (HT), are not well[Page 51] understood by medical scientists and practitioners although there has been a long-standing belief that mental or emotional factors may be involved. During the 1930s-1950s, psychoanalytically oriented practitioners and researchers, representing the psychosomatic movement, emphasized that mental and emotional distress can contribute to the development of physical disorders. Two leaders of the psychosomatic movement, Flanders Dunbar and Franz Alexander, proposed that inhibition of angry feelings contributes to the development of HT. They reasoned that hostile provocation typically is associated with increases in blood pressure (BP), but after the anger is expressed, BP typically decreases. However, according to the anger-suppression hypothesis, some persons are personally predisposed to suppress their rage. This leads to recurrent autonomic arousal, which eventually leads to chronically elevated BP. According to this idea, the habitual tendency to suppress angry feelings was conceptualized as a personality trait that represented a fear or anxiety about expressing anger to others. Alexander also thought that some constitutional physical predisposition and a stressful, precipitating condition, such as a serious interpersonal conflict or death of a close relative, were also necessary conditions for the development of HT, but these qualifiers have not tended to receive attention from subsequent researchers.

From its inception, the idea of a “hypertensive personality” was controversial among physicians who were skeptical about a role for emotional and mental factors in the development of HT. Although the psychoanalytic approach waned in influence, interest in this topic reemerged with the rise of behavioral medicine and health psychology. In the past three decades, nearly 50 studies testing the anger expression hypothesis have been published.