Anger suppression, reactivity, and hypertension risk: Gender makes a difference


The present study investigated gender-related differences in cardiovascular reactivity and the role of anger inhibition and risk for future hypertension.

Tonic blood pressure served as an index of hypertension risk. Twenty-eight female and 26 male college students with high and low normal blood pressure were recruited on the basis of their mean arterial pressure. Continuous measures of heart rate and blood pressure were taken while participants carried out a series of behavioral manoeuvres including mental arithmetic, interpersonal challenge, a frustrating psychomotor test, and the cold pressor test. Participants also completed inventories assessing trait anxiety, trait anger, anger expression, and Type A.

The results are in concordance with previous findings and show higher cardiovascular reactivity in men than in women and in subjects at risk for hypertension. Within the male group, a combination of hypertension risk and anger suppression led to the highest reactivity, whereas in female subjects, differences in anger-in had no effect on reactivity. The implications of these results are discussed in light of sex differences in cardiovascular morbidity and mortality.

This is a preview of subscription content, access via your institution.


  1. (1)

    Manuck SB, Kasprowicz AL, Monroe SM, Larkin KT, Kaplan JR: Psychophysiologic reactivity as a dimension of individual differences. In Schneiderman N, Weiss SM, Kaufmann PG (eds),Handbook of Research Methods in Cardiovascular Behavioral Medicine. New York: Plenum, 1989, 362–382.

    Google Scholar 

  2. (2)

    Steptoe A, Vögele C: The methodology of mental stress testing in cardiovascular research.Circulation. 1991,83(Suppl. II): II-14–II-24.

    CAS  Google Scholar 

  3. (3)

    Fredrikson M, Matthews KA: Cardiovascular responses to behavioral stress and hypertension: A meta-analytical review.Annals of Behavioral Medicine. 1990,12: 30–39.

    Article  Google Scholar 

  4. (4)

    Sallis JF, Dimsdale JE, Caine C: Blood pressure reactivity in children.Journal of Psychosomatic Research. 1988,32: 1–12.

    PubMed  Article  CAS  Google Scholar 

  5. (5)

    Fredrikson M, Robson A, Ljungdell T: Ambulatory and laboratory blood pressure in individuals with negative and positive family history of hypertension.Health Psychology. 1991,10: 371–377.

    PubMed  Article  CAS  Google Scholar 

  6. (6)

    Allen MT, Lawler KA, Mitchell VP, et al: Type A behavior, parental history of hypertension, and cardiovascular reactivity in college males.Health Psychology. 1987,6: 113–130.

    PubMed  Article  CAS  Google Scholar 

  7. (7)

    Paffenbarger RS, Thorn MC, Wing AL: Chronic disease in former college students. VIII. Characteristics in youth predisposing to hypertension in later years.American Journal of Epidemiology. 1968,88: 25–32.

    PubMed  Google Scholar 

  8. (8)

    Rabkin SW, Mathewson FAL, Tate RB: Relationship of blood pressure in 20–39 year old men to subsequent blood pressure and incidence of hypertension over a 30-year observation period.Circulation. 1982,65: 291–296.

    PubMed  CAS  Google Scholar 

  9. (9)

    Kahn HA, Medalie JH, Neufeld HN, Riss E, Goldbourt U: The incidence of hypertension and associated factors: The Israeli Ischaemic Heart Study.American Heart Journal. 1972,84: 171–182.

    PubMed  Article  CAS  Google Scholar 

  10. (10)

    Julius M, Harburg E, Cottington EM, Johnson EH: Anger-coping types, blood pressure, and all-cause mortality: A follow-up in Tecumseh-Michigan (1971–1983).American Journal of Epidemiology. 1986,124: 220–233.

    PubMed  CAS  Google Scholar 

  11. (11)

    Cottington EM, Matthews KA, Talbert D, Kuller LH: Occupational stress, suppressed anger, and hypertension.Psychosomatic Medicine. 1986,48: 249–260.

    PubMed  CAS  Google Scholar 

  12. (12)

    Perini C, Müller FB, Bühler FR: Suppressed aggression accelerates early development of essential hypertension.Journal of Hypertension. 1991,9: 499–503.

    PubMed  Article  CAS  Google Scholar 

  13. (13)

    Holroyd KA, Gorkin L: Young adults at risk for hypertension: Effects of family history and anger management in determining responses to interpersonal conflict.Journal of Psychosomatic Research. 1983,27: 131–138.

    PubMed  Article  CAS  Google Scholar 

  14. (14)

    Jorgensen RS, Houston BK: Family history of hypertension, personality patterns, and cardiovascular reactivity to stress.Psychosomatic Medicine. 1986,48: 102–117.

    PubMed  CAS  Google Scholar 

  15. (15)

    Vögele C, Steptoe A: Emotional coping and tonic blood pressure as determinants of cardiovascular responses to mental stress.Journal of Hypertension, 1992,10: 1079–1087.

    PubMed  Google Scholar 

  16. (16)

    Vögele C, Steptoe A: Anger inhibition and family history as modulators of cardiovascular responses to mental stress in adolescent boys.Journal of Psychosomatic Research. 1993,37: 503–514.

    PubMed  Article  Google Scholar 

  17. (17)

    Matthews KA, Stoney CM: Influences of sex and age on cardiovascular responses during stress.Psychosomatic Medicine. 1988,50: 46–56.

    PubMed  CAS  Google Scholar 

  18. (18)

    McAdoo WG, Weinberger MH, Miller JZ, et al: Race and gender influence hemodynamic responses to psychological and physical stimuli.Journal of Hypertension. 1990,8: 961–967.

    PubMed  Article  CAS  Google Scholar 

  19. (19)

    Stoney CM, Davis MC, Matthews KA: Sex differences in physiological responses to stress and coronary heart disease: A causal link?Psychophysiology. 1987,24: 127–131.

    PubMed  Article  CAS  Google Scholar 

  20. (20)

    Stoney CM, Matthews KA, McDonald RH, Johnson CA: Sex differences in lipid, lipoprotein, cardiovascular, and neuroendocrine responses to acute stress.Psychophysiology. 1988,25: 645–656.

    PubMed  Article  CAS  Google Scholar 

  21. (21)

    Treiber FA, Davis H, Musante L, et al: Ethnicity, gender, family history of myocardial infarction, and hemodynamic responses to laboratory stressors in children.Health Psychology. 1993,12: 6–15.

    PubMed  Article  CAS  Google Scholar 

  22. (22)

    Lash SJ, Gillespie BL, Eisler RM, et al: Sex differences in cardiovascular reactivity: Effects of the gender relevance of the stressor.Health Psychology. 1991,10: 392–398.

    PubMed  Article  CAS  Google Scholar 

  23. (23)

    Lai JY, Linden W: Gender, age, expression style, and opportunity for anger release determine cardiovascular reaction to and recovery from anger provocation.Psychosomatic Medicine. 1992,54: 297–310.

    PubMed  CAS  Google Scholar 

  24. (24)

    Stoney CM: The role of reproductive hormones in cardiovascular and neuroendocrine function during behavioral stress. In Turner R, Sherwood A, Light KC (eds),Individual Differences in Cardiovascular Response to Stress. New York: Plenum, 1992, 147–163.

    Google Scholar 

  25. (25)

    Rosenman RH: Health consequences of anger and implications for treatment. In Chesney MA, Rosenman RH (eds),Anger and Hostility in Cardiovascular and Behavioral Disorders. Washington, DC: Hemisphere, 1985, 103–126.

    Google Scholar 

  26. (26)

    Markowitz JH, Matthews KA, Kannel WB, Cobb JL, D’Agostino RB: Psychological predictors of hypertension in the Framingham Study: Is there tension in hypertension?Journal of the American Medical Association. 1993,270: 2439–2443.

    Article  Google Scholar 

  27. (27)

    Lovallo W: The cold pressor test and autonomic function: A review and integration.Psychophysiology. 1975,12: 268–282.

    PubMed  Article  CAS  Google Scholar 

  28. (28)

    Sprangers RLH: On the role of cardiopulmonary receptors at the onset of muscular exercise. Unpublished Manuscript, Proefschrift, University of Amsterdam, 1990.

  29. (29)

    Rostrup M, Ekeberg O: Awareness of high blood pressure influences on psychological and sympathetic responses.Journal of Psychosomatic Research. 1992,36: 117–123.

    PubMed  Article  CAS  Google Scholar 

  30. (30)

    Wesseling KH, Settels JJ, De Witt B: The measurement of continuous finger arterial pressure non-invasively in stationary subjects. In Schmidt TH, Dembroski TM, Blümchen G (eds),Biological and Psychological Factors in Cardiovascular Disease. Berlin, Germany: Springer, 1986, 355–375.

    Google Scholar 

  31. (31)

    Parati G, Casedei R, Groppelli A, Di Rienzo M, Mancia G: Continuous non-invasive finger blood pressure monitoring at rest and during laboratory testing: Evaluation by intra-arterial monitoring.Hypertension. 1989,13: 647–655.

    PubMed  CAS  Google Scholar 

  32. (32)

    Imholz BPM, Wieling W, Langewouters GJ, Van Montfrans GA: Continuous finger arterial pressure: Utility in the cardiovascular laboratory.Clinical Autonomic Research. 1991,1: 43–53.

    PubMed  Article  CAS  Google Scholar 

  33. (33)

    Spielberger CD:State-Trait Anger Expression Inventory (STAXI). Research Edition, Odessa, FL: Psychological Assessment Resources, 1988.

    Google Scholar 

  34. (34)

    Spielberger CD:Preliminary Manual for the State-Trait Personality Inventory (STPI). Tampa, FL: Center for Research in Behavioral Medicine and Health Psychology, University of Southern Florida, 1979.

    Google Scholar 

  35. (35)

    Jenkins CD, Zyzanski SJ, Rosenman RH:Manual of the Jenkins Activity Survey (JAS). New York: The Psychological Corporation, 1979.

    Google Scholar 

  36. (36)

    Girdler SS, Turner JR, Sherwood A, Light KC: Gender differences in blood pressure control during a variety of behavioral stressors.Psychosomatic Medicine. 1990,52: 571–591.

    PubMed  CAS  Google Scholar 

  37. (37)

    Matthews KA, Davis MC, Stoney CM, Owens JF, Caggiula A: Does the gender relevance of the stressor influence sex differences in psychophysiological responses?Health Psychology. 1991,10: 112–120.

    PubMed  Article  CAS  Google Scholar 

  38. (38)

    Houston BK: Cardiovascular and neuroendocrine reactivity, global Type A, and components of Type A behavior. In Houston BK, Snyder CR (eds),Type A Behavior Pattern: Research, Theory, and Intervention. New York: Wiley, 1988, 212–253.

    Google Scholar 

  39. (39)

    Parati G, Di Rienzo M, Bertinieri G, et al: Evaluation of the baroreceptor-heart rate reflex by 24-hour intra-arterial blood pressure monitoring in humans.Hypertension. 1988,12: 214–222.

    PubMed  CAS  Google Scholar 

  40. (40)

    Steptoe A, Sawada Y: Assessment of baroreceptor reflex function during mental stress and relaxation.Psychophysiology. 1989,26: 140–147.

    PubMed  Article  CAS  Google Scholar 

  41. (41)

    Steptoe A, Vögele C: Cardiac baroreflex function during postural change assessed using non-invasive spontaneous sequence analysis in young men.Cardiovascular Research. 1990,24: 627–632.

    PubMed  CAS  Article  Google Scholar 

  42. (42)

    McCubbin JA, Surwitt RS, Williams RB: Opioid dysfunction and risk for hypertension: Naloxone and blood pressure responses during different types of stress.Psychosomatic Medicine. 1988,50: 8–14.

    PubMed  CAS  Google Scholar 

  43. (43)

    Sims J, Carroll D: Cardiovascular and metabolic activity at rest during psychological and physical challenge in normotensives and subjects with mildly elevated blood pressure.Psychophysiology. 1990,27: 149–156.

    PubMed  Article  CAS  Google Scholar 

  44. (44)

    Light KC, Obrist PA, Sherwood A, James SA, Strogatz DS: Effects of race and marginally elevated blood pressure on responses to stress.Hypertension. 1987,10: 555–563.

    PubMed  CAS  Google Scholar 

  45. (45)

    Thomas CB, Duszcynski KR: Blood pressure levels in young adulthood as predictors of hypertension and the fate of the cold pressor test.Johns Hopkins Medical Journal. 1982,151: 93–100.

    PubMed  CAS  Google Scholar 

  46. (46)

    Everson SA, Lovallo WR, Sausen KP, Wilson MF: Hemodynamic characteristics of young men at risk for hypertension at rest and during laboratory stressors.Health Psychology. 1992,11: 24–31.

    PubMed  Article  CAS  Google Scholar 

  47. (47)

    Lazarus R, Folkman S:Stress, Appraisal, and Coping. New York: Springer, 1984.

    Google Scholar 

  48. (48)

    Weidner G, Messina CR: Effects of gender-typed tasks and gender roles on cardiovascular reactivity.International Journal of Behavioral Medicine. 1995,2: 66–82.

    PubMed  Article  CAS  Google Scholar 

  49. (49)

    Polefrone JM, Manuck SB: Gender differences in cardiovascular and neuroendocrine response to stressors. In Barnett RC, Biener L, Baruch GK (eds),Gender and Stress. New York: Free Press, 1987, 13–38.

    Google Scholar 

  50. (50)

    Saab PG: Cardiovascular and neuroendocrine response to challenge in males and females. In Schneiderman N, Weiss SM, Kaufman PG (eds),Handbook of Research Methods in Cardiovascular Behavioral Medicine. New York: Plenum, 1989, 453–481.

    Google Scholar 

  51. (51)

    Saab PG, Matthews KA, Stoney CM, McDonald RH: Premenopausal and postmenopausal women differ in their cardiovascular and neuroendocrine responses to behavioral stress.Psychophysiology. 1989,26: 270–280.

    PubMed  Article  CAS  Google Scholar 

  52. (52)

    Collins A, Hanson U, Eneroth P, et al: Psychophysiological stress responses in postmenopausal women before and after hormonal replacement therapy.Human Neurobiology. 1982,1: 153–159.

    PubMed  CAS  Google Scholar 

  53. (53)

    Lundberg U, Hanson U, Andersson K, et al: Hirsute women with elevated androgen levels: Psychological characteristics, steroid hormones, and catecholamines.Journal of Psychosomatic Obstetrics and Gynaecology. 1983,2: 86–93.

    Article  Google Scholar 

  54. (54)

    Ballard ME, Cummings EM, Larkin K: Emotional and cardiovascular responses to adults’ angry behavior and to challenging tasks in children of hypertensive and normotensive parents.Child Development. 1993,64: 500–515.

    PubMed  Article  CAS  Google Scholar 

  55. (55)

    Linden W: Gender differences in the social conflict model of anger expression. American Psychological Association 101 Meeting. Toronto, Canada: 1993.

  56. (56)

    Linden W, Feuerstein M: Essential hypertension and social coping behavior.Journal of Human Stress. 1981,7: 28–34.

    PubMed  CAS  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Claus Vögele.

About this article

Cite this article

Vögele, C., Jarvis, A. & Cheeseman, K. Anger suppression, reactivity, and hypertension risk: Gender makes a difference. ann. behav. med. 19, 61–69 (1997).

Download citation


  • Mental Stress
  • Mental Arithmetic
  • Cardiovascular Reactivity
  • Cold Pressor Test
  • Baroreflex Sensitivity