Suppressed aggression accelerates early development of essential hypertension

Predictors for early development of essential hypertension were identified in a prospective study of 98 normotensive and 23 borderline hypertensive subjects of both sexes aged 18-24 years. Baseline examination included psychological tests as well as resting and stress-induced cardiovascular and neurohormonal measurements. During the 30 (+/- 4 s.d.)-month follow up, 14 out of 98 (14%) initially normotensive subjects developed borderline hypertension, while of 23 borderline hypertensive subjects, 11 (48%) remained in the borderline group (141-159/91-94 mmHg), another five (22%) increased to greater than 160/95 mmHg and seven (30%) normalized blood pressure to less than 140/90 mmHg. In the 98 normotensive subjects, the height of casual systolic blood pressure at entry was the best predictor of subsequent borderline hypertension, correctly classifying 75% of the subjects in a stepwise discriminant analysis. Stress-induced blood pressure responses, together with measures of sympathetic nervous system activity (11%) and psychological factors (6%), were relatively weak predictors of subsequent pressure classification. In the 23 borderline hypertensives, the height of systolic blood pressure induced by mental stress was the single best predictor for sustained borderline or subsequent established hypertension, classifying 74%. When all 121 subjects were taken together, the greatest increases in blood pressure were found in those subjects who had suppressed aggression, particularly those who also had normal-high or borderline blood pressure at entry. Thus, suppressed aggression emerged as a superimposed permissive factor for a steeper trajectory or acceleration of early development of hypertension.