Background

High levels of anger are associated with an increased risk of cardiovascular disease, but little is known about the role of subscales of anger experience and expression in hypertension risk. This case-control study was conducted to investigate the association between anger experience or anger expression and hypertension, especially after controlling the effect of individual standards of anger expression.

Methods
From September 1998 through December 1998, one hundred one hypertensives treated at the family medicine ambulatory clinic of a university hospital, were individually matched by age (±5 years) and sex with the same number of patients who visited for other reasons (reponse rate 98%). A Korean version of Spielberger Anger Expression Scale was used to obtain information on subscales of anger experience and expression through self-reporting or structured interview from a nurse.

Results
Anger trait response score was lower in the case group compared to the control group (P=0.04). No significant associations were found for anger-out, standards of anger expression, history of anger expression, and subjects to whom anger was expressed. Each 1-point increase in anger trait response, anger-in, and anger-control was significantly associated with a decrease in odds ratio by 0.78 (95% CI; 0.61∼0.98), 0.83 (95% CI; 0.72∼0.96), and 0.89 (95% CI; 0.81∼0.97), respectively, after controlling for age, education level, income, exercise habit, standards of anger expression and current BP.

Conclusion
Hypertensives are less likely to show anger response, anger-in, and anger-control, but cohort studies are needed to clarify the cause-effect relationship in the future.