Anger expression and incident hypertension

Susan A. Everson, Debbie E. Goldberg, George A. Kaplan, Juhani Julkunen, Jukka T. Salonen

Research output: Contribution to journalArticlepeer-review

143 Scopus citations


Objective: It has long been thought that anger is important in the development of essential hypertension. However, tests of this hypothesis have yielded conflicting findings. This study prospectively examined the relationship between anger expression style and incident hypertension in a population sample of middle-aged men. Methods: Participants were 537 initially normotensive men from eastern Finland, who completed a medical examination and series of psychological questionnaires at baseline and at 4- year follow-up. Anger expression was assessed by Spielberger's Anger-out and Anger-in scales. Results: At follow-up, 104 men (19.4%) were hypertensive (blood pressure ≥ 165 mm Hg systolic and/or 95 mm Hg diastolic). Age- adjusted logistic regression analyses revealed that each 1-point increase in Anger-out was associated with a 12% increase in risk of hypertension after 4 years of follow-up (p < .002), which corresponded to a two-fold increased risk of hypertension among men with scores in the top tertile of the Anger- out scale, relative to those with scores in the bottom tertile (odds ratio = 2.00, 95% confidence interval 1.20-3.38). Each 1-point increase on the Anger- in scale also was related to a 12% increased risk of hypertension (p < .01). Adjustments for body mass index, smoking, alcohol consumption, physical activity, a positive parental history of hypertension, and baseline resting diastolic blood pressure had little impact on the findings. Conclusions: These data provide strong epidemiological evidence for a positive relationship between anger expression style and subsequent hypertension, independent of known risk factors. Findings support the hypothesis that extreme expression of anger in either direction has adverse cardiovascular consequences.

Original languageEnglish (US)
Pages (from-to)730-735
Number of pages6
JournalPsychosomatic medicine
Issue number6
StatePublished - 1998


  • Anger expression
  • Cardiovascular disease
  • Hypertension
  • Risk factors


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