The role of anger and hostility in essential hypertension and coronary heart disease.

A critical review of the literature pertaining to the role of anger and hostility in essential hypertension and coronary heart disease is presented. Psychodynamic, personality, and psychophysiological approaches are covered. Anger and hostility appear to play an important role in the development of hypertension, though the mechanism is not yet clearly specified. In the coronary heart disease literature, aggression is more commonly referred to than anger; recent evidence suggests, however, that hostility may be a highly significant component of the Type A coronary-prone behavior pattern. The research reviewed is seen as providing support for the utility of emotion as a construct relevant to understanding psychophysiological mechanisms associated with cardiovascular disorders. Psychological and emotional factors have long been implicated in essential hypertension and coronary heart disease. The present review focuses specifically on the emotional complex of anger and hostility in the etiology and pathogenesis of these major cardiovascular disorders. Relations between anger and hostility and the cardiovascular disorders are comprehensively examined by drawing on the psychodynainic, personality, social psychological, and psychophysiological research literatures. In my view emotional behavior can serve as a basic construct linking psychological factors to pathophysiological processes. There is much definitional confusion regarding emotion, and no single comprehensive theory exists that has relevance to all aspects of the subject (Plutchik, 1980). For the purposes of this article, the term emotional behavior, following Plutchik (1980), refers to a complex sequence of reactions that include cognitive evaluations, subjective changes, physiological changes (autonomic arousal), and action tendencies with both instrumental and expressive qualities. The components of emotional behavior that are most often referred to here are hostility and anger.