November 7, 2003
Impatient, Hostile Young Adults at Risk for High Blood Pressure
CHICAGO— Young adults who are impatient and hostile are at risk for developing high blood pressure, and consequently, cardiovascular disease, as they get older, a Northwestern University study found.
The study, results of which were published in the October 22 issue of the Journal of the American Medical Association, also found a dose-response increase in long-term risk for hypertension—that is, the more intense the impatience or hostility, the greater the risk. However, other psychological and social factors, such as competitiveness, depression, and anxiety, did not appear to raise high blood pressure risk.
Around 50 million Americans—one in four adults—have high blood pressure, and its prevalence increases sharply with age. About 3 percent of those aged 18 to 24 and about 70 percent of those 75 and older have high blood pressure, according to the National Heart, Lung, and Blood Institute.
The JAMA article, by Lijing L. Yan, PhD, MPH, research assistant professor of preventive medicine at the Feinberg School of Medicine at Northwestern University, and colleagues, describes the first prospective study to examine as a group the effects of key “type A” behaviors, as well as depression and anxiety, on the long-term risk for hypertension. Previous studies have had inconsistent results.
Dr. Yan and co-researchers used data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, which included approximately 3,300 black and white adults aged 18 to 30 who lived in four metropolitan areas. Participants were enrolled in the study in 1985 and 1986 and followed up through 2000 and 2001, with assessments taken for psychosocial factors and high blood pressure.
The investigators assessed five psychological/social factors: time urgency/impatience, achievement striving/competitiveness, hostility, depression, and anxiety. The first three are key components of the type A behavior pattern and were assessed at the start of the study; depression and anxiety were assessed five years later.
Results of the study showed that 15 percent of all participants had developed hypertension 15 years later, by ages 33 to 45. The researchers found a dose-response increase in risk for developing hypertension associated with a higher tendency of time urgency/impatience and hostility but not achievement striving/competitiveness, depression, or anxiety.
Results were similar for blacks and whites and were unaffected by age, gender, race, blood pressure at the time of enrollment, and education. The presence of established hypertension risk factors, such as overweight/obesity, alcohol consumption, and physical inactivity did not affect results.
“Although high blood pressure is less common among young adults, young adulthood and early middle age is a critical period for the development of hypertension and other risk factors for heart disease,” Dr. Yan said. “Previous research on young adults is limited. Our study helps to fill that gap.”
Collaborating with Dr. Yan on this study were Kiang J. Liu, PhD, professor of preventive medicine, and Martha L. Daviglus, MD, associate professor of preventive medicine, both at the Feinberg School, and researchers from the University of Pittsburgh, University of Alabama at Birmingham, and Birmingham Veterans Affairs Medical Center.
This research was supported by grants from the National Heart, Lung, and Blood Institute of the National Institutes of Health.