Journal of Behavioral Medicine

, Volume 28, Issue 5, pp 443–454 | Cite as

Suppressed Hostility Predicted Hypertension Incidence Among Middle-Aged Men: The Normative Aging Study

  • Jianping ZhangEmail author
  • Raymond Niaura
  • John F. Todaro
  • Jeanne M. McCaffery
  • Biing-Jiun Shen
  • Avron SpiroIII
  • Kenneth D. Ward

This study tested whether suppressed hostility predicted incident hypertension (HTN) in initially nonhypertensive men, using prospective data from the Normative Aging Study. Six hundred twenty-seven men who completed the MMPI and participated in a subsequent laboratory assessment were included in the study. The Cook–Medley Hostility scale (Ho), a suppression factor, and other risk factors were used to predict incident HTN over a 3-year period. Logistic regression showed a significant three-way interaction among Ho, suppression, and age in predicting incident HTN. Among middle-aged men (≤60 years) with higher suppression, a 1-point decrease in the Ho score was associated with an 18% increase in HTN risk. This relationship remained significant after controlling for relevant risk factors. Among older participants, the Ho × Suppression interaction was not predictive of HTN incidence. These results provide support for the Suppressed Hostility hypothesis in middle-aged men.


hostility suppression aging incident hypertension 



The VA Normative Aging Study (NAS) is supported by the Cooperative Studies Program/ERIC, US Department of Veterans Affairs, and is a research component of the Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC). Some of the data analyzed in this project were obtained with support provided by Grants HL37871 and AG02287


  1. Alexander, F. (1939). Emotional factors in essential hypertension. Psychosom. Med. 1: 175–179.Google Scholar
  2. Barefoot, J. C. (1992). Developments in the measurement of hostility. In Friedman, H. S. (Ed.), Hostility, coping, and health. American Psychological Association, Washington, DC, pp. 43–66.Google Scholar
  3. Barefoot, J. C., Dodge, K. A., Peterson, B. L., Dahlstrom, W. G., and Williams, R. B. (1989). The Cook-Medley Hostility Scale: Item content and ability to predict survival. Psychosom. Med. 51: 46–57.PubMedGoogle Scholar
  4. Bosse, R., Ekedert, D. J., and Silbert, J. E. (1984). The Vetrans Administration Normative Aging Study. In Mednick, S. A. MH, and Finello, K. M. (Eds.), Handbook of longitudinal research: Teenage and adult cohorts, Vol. 2. Preager, New York, pp. 273–293.Google Scholar
  5. Brosschot, J. F., and Thayer, J. F. (1998). Anger inhibition, cardiovascular recovery, and vagal function: A model of the link betweem hostility and cardiovascular disease. Ann. Behav. Med. 20: 326–332.PubMedGoogle Scholar
  6. Bruehl, S., McCubbin, J. A., Wilson, J. F., and Montgomery, T. (1994). Coping styles, opioid blockade, and cardiovascular response to stress. J. Behav. Med. 17(1): 25–40.PubMedCrossRefGoogle Scholar
  7. Butcher, J. N., Dahlstrom, W. G., Grahm, J. R., Tellegen, A., and Kaemmer, B. (1989). MMPI-2: Minnesota Multiphasic Personality Inverntory-2. Manual for administration and scoring. University of Minnesota, Minneapolis.Google Scholar
  8. Carroll, D., Smith, G. D., Shipley, M. J., Steptoe, A., Brunner, E. J., and Marmot, M. G. (2001). Blood pressure reactions to acute psychological stress and future blood pressure status: a 10-year follow-up of men in the Whitehall II study. Psychosom. Med. 63: 737–743.PubMedGoogle Scholar
  9. Cattell, R. B., and Vogelmann, S. (1977). A comprehensive trial of the scree and KG criteria for determining the number of factors. Multivariate Behav. Res. 12: 289–325.CrossRefGoogle Scholar
  10. Chobanian, A. V., Bakris, G. L., Black, H. R., Cushman, W. C., Green, L. A., Izzo, J. L., Jr., Jones, D. W., Materson, B. J., Oparil, S., Wright, J. T., Jr., et al. (2003). The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report. JAMA 289(19): 2560–2571.PubMedCrossRefGoogle Scholar
  11. Cochrane, R. (1973). Hostility and neuroticism among unselected essential hypertensives. J. Psychosom. Res. 17: 215–218.PubMedCrossRefGoogle Scholar
  12. Cook, W. W., and Medley, D. M. (1954). Proposed hostility and pharisaic-virtue scales from the MMPI. J. Appl. Psychol. 38: 414–418.CrossRefGoogle Scholar
  13. Cox, D. R., and Oakes, D. (1984). Analysis of survival data. Chapman & Hall, London.Google Scholar
  14. Diamond, E. L. (1982). The role of anger and hostility in essential hypertension and coronary heart disease. Psychol. Bull. 92: 410–433.PubMedCrossRefGoogle Scholar
  15. Edwards, A. L. (1957). The social desirability variable in personality assessment and research. Dryden, New York.Google Scholar
  16. Esler, M., Julius, S., Zweifler, A., Randall, O., Harburg, E., Gardiner, H., and DeQuattro, V. (1977). Mild high-renin essential hypertension: Neurogenic human hypertension? New Engl. J. Med. 296: 405–411.PubMedCrossRefGoogle Scholar
  17. Everson, S. A., Goldberg, D. E., Kaplan, G. A., Julkunen, J., and Salonen, J. T. (1998). Anger expression and incident hypertension. Psychosom. Med. 60: 730–735.PubMedGoogle Scholar
  18. Everson, S. A., Kaplan, G. A., Goldberg, D. E., and Salonon, J. T. (1996). Anticipatory blood pressure response to exercise predicts future high blood pressure in middle-aged men. Hypertension 27: 1059–1064.PubMedGoogle Scholar
  19. Harburg, E., Erfurt, J. C., Hauenstein, L. S., Chape, C., Schull, W. J., and Schork, M. A. (1973). Social-ecological stress, suppressed hostility, skin color, and black-white male blood pressure: Detroit. Psychosom. Med. 35: 276–297.PubMedGoogle Scholar
  20. Helmers, K. F., and Krantz, D. S. (1996). Defensive hostility, gender and cardiovascular levels and responses to stress. Ann. Behav. Med. 18(4): 246–254.PubMedGoogle Scholar
  21. Helmers, K. F., Krantz, D. S., Merz, C. N. B., Klein, J., Kop, W. J., Gottdiener, J. S., and Rozanski, A. (1995). Defensive hostility: Relationship to multiple markers of cardiac ischemia in patients with coronary disease. Health Psychol. 14(3): 202–209.PubMedCrossRefGoogle Scholar
  22. Jamner, L. D., and Schwartz, G. E. (1986). Self-deception predicts self-report and endurance of pain. Psychosom. Med. 48(3–4): 211–223.PubMedGoogle Scholar
  23. Jamner, L. D., Schwartz, G. E., and Leigh, H. (1988). The relationship between repressive and defensive coping styles and monocyte, eosinophile, and serum glucose levels: Support for the opioid peptide hypothesis of repression. Psychosom. Med. 50(6): 567–575.PubMedGoogle Scholar
  24. Jamner, L. D., Shapiro, D., Goldstein, I. B., and Hug, R. (1991). Ambulatory blood pressure and heart rate in paramedics: Effects of cynical hostility and defensiveness. Psychosom. Med. 53: 393–406.PubMedGoogle Scholar
  25. Jonas, B. S., Franks, P., and Ingram, D. D. (1997). Are symptoms of anxiety and depression risk factors for hypertension? Arch. Fam. Med. 6: 43–49.PubMedCrossRefGoogle Scholar
  26. Jorgensen, R. S., Abdul-Karim, K., Kahan, T. A., and Frankowski, J. J. (1995). Defensiveness, cynical hostility and cardiovascular reactivity: A moderator analysis. Psychotherapeut. Psychosom. 64: 156–161.CrossRefGoogle Scholar
  27. Jorgensen, R. S., Frankowski, J. J., Lantinga, L. J., Phadke, K., Sprafkin, R. P., and Abdul-Karim, K. W. (2001). Defensive hostility and coronary heart disease: A preliminary investigation of male veterans. Psychosom. Med. 63: 463–469.PubMedGoogle Scholar
  28. Jorgensen, R. S., Gelling, P. D., and Kliner, L. (1992). Patterns of social desirability and anger in young men with a parental history of hypertension: Association with cardiovascular activity. Health Psychol. 11(6): 403–412.PubMedCrossRefGoogle Scholar
  29. Jorgensen, R. S., and Houston, B. K. (1986). Family history of hypertension, personality patterns, and cardiovascular reactivity to stress. Psychosom. Med. 48(1): 102–117.PubMedGoogle Scholar
  30. Jorgensen, R. S., Johnson, B. T., Kolodziej, M. E., Schreer, G. E. (1996). Elevated blood pressure and personality: A meta-analytic review. Psychol. Bull. 120: 293–320.PubMedCrossRefGoogle Scholar
  31. Jula, A., Salminen, J. K., and Saarijarvi, S. (1999). Alexithymia: A facet of essential hypertension. Hypertension 33: 1057–1061.PubMedGoogle Scholar
  32. Julius, M., Harburg, E., Cottington, E. M., and Johnson, E. H. (1986). Anger-coping types, blood pressure, and all-cause mortality: A follow-up in Tecumseh, Michigan (1971–1983). Am. J. Epidemiol. 124: 220–233.PubMedGoogle Scholar
  33. Kahn, H. A., Medalie, J. H., Neufeld, H. N., Reise, E., and Goldbourt, U. (1972). The incidence of hypertension and associated factors: The Isreali ischemic heart disease study. Am. Heart J. 84: 171–182.PubMedCrossRefGoogle Scholar
  34. Krantz, D. S. C. (1987). Report of Task Force 1: Psychosocial factors in hypertension. Circulation 76(Suppl. I): 184–188.Google Scholar
  35. Laude, D., Girard, A., Consoli, S., Mounier-Vehier, C., and Elghozi, J. L. (1997). Anger expression and cardiovascular reactivity to mental stress: A spectral analysis approach. Clin. Exp. Hypertens. 19(5–6): 901–911.PubMedGoogle Scholar
  36. Little, K. B., and Fisher, J. (1958). Two new experimental scales of the MMPI. J. Consult. Psychol. 22: 305–306.PubMedCrossRefGoogle Scholar
  37. Mann, S. J., and James, G. D. (1998). Defensiveness and essential hypertension. J. Psychosom. Res. 45: 139–148.PubMedCrossRefGoogle Scholar
  38. Markovitz, J. H., Matthews, K. A., Kannel, W. B., Cobb, J. L., and D’Agostino, R. B. (1993). Psychological predictors of hypertension in the Framingham Study: Is there tension in hypertension? JAMA 270(20): 2439–1443.PubMedCrossRefGoogle Scholar
  39. Markovitz, J. H., Matthews, K. A., Wing, R. R., Kuller, L. H., and Meilahn, E. N. (1991). Psychological, biological and health behavior predictors of blood pressure changes in middle-aged women. J. Hypertens. 9(5): 399–406.PubMedCrossRefGoogle Scholar
  40. McCrae, R. R., and Costa, P. T. (1983). Social Desirability Scales: More substance than style. J. Consult. Clin. Psychol. 51: 882–888.CrossRefGoogle Scholar
  41. Mente, A., and Helmers, K. F. (1999). Defensive hostility and cardiovascular responses to stress in young men. Pers. Individual Diff. 27: 683–694.CrossRefGoogle Scholar
  42. Mohrman, D. E., and Heller, L. J. (1991). Cardiovascular physiology. McGraw-Hill, New York, NY.Google Scholar
  43. Pollack, H., and Krueger, D. E. (1960). Epidemiology of cardiovascular diseases methodology: Hypertension and arteriosclerosis. Am. J. Pub. Health 50: 1–125.CrossRefGoogle Scholar
  44. Rutledge, T., and Hogan, B. E. (2002). A quantitative review of prospective evidence linking psychological factors with hypertension development. Psychosom. Med. 64: 758–766.PubMedCrossRefGoogle Scholar
  45. Rutledge, T., and Linden, W. (2000). Defensiveness status predicts 3-year incidence of hypertension. J. Hypertens. 18(2): 153–159.PubMedCrossRefGoogle Scholar
  46. Saul, L. (1939). Hostility in cases of essential hypertension. Psychosom. Med. 1: 153–161.Google Scholar
  47. Schneiderman, N., Chesney, M. A., and Krantz, D. S. (1989). Biobehavioral aspects of cardiovascular disease: Progress and prospects. Health Psychol. 6: 649–676.CrossRefGoogle Scholar
  48. SHEP Cooperative Research Group. (1991). Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension: Final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA 265: 255–264.CrossRefGoogle Scholar
  49. Sommers-Flanagan, J., and Greenberg, R. P. (1989). Psychosocial variables and hypertension: A new look at an old controversy. J. Nerv. Ment. Dis. 177: 15–24.PubMedCrossRefGoogle Scholar
  50. Spiro, A. I., Aldwin, C. M., Ward, K. D., and Mroczek, D. K. (1995). Personality and the incident hypertension among older men: Longitudinal findings from the Normative Aging Study. Health Psychol. 14: 563–569.PubMedCrossRefGoogle Scholar
  51. Staessen, J., Amery, A., and Fagard, R. (1990). Isolated systolic hypertension in the elderly. J. Hypertens. 8: 393–405.PubMedCrossRefGoogle Scholar
  52. Suls, J., Wan, C. K., and Costa, P. T. (1995). Relationship of trait anger to resting blood pressure: A Meta-analysis. Health Psychol. 14: 444–456.PubMedCrossRefGoogle Scholar
  53. Ullmann, L. P. (1962). An empirically derived MMPI scale which measures facilitation-inhibition of recognition of threatening stimuli. J. Clin. Psychol. 18(2): 127–132.CrossRefGoogle Scholar
  54. Weinberger, D. A., Schwartz, G. E., and Davidson, R. J. (1979). Low-anxious, high-anxious, and pressive coping styles: Psychometric patterns and behavioral and physiological responses to stress. J. Abnorm.Psychol. 88(4): 369–380.PubMedCrossRefGoogle Scholar
  55. Willett, W. C., Sampson, L., Stampfer, M. J., Rosner, B., Bain, C., and Witschi, J. (1985). Reproducibility and validity of a semi-quantitative food frequency questionnaire. Am. J. Epidemiol. 122: 51–65.PubMedGoogle Scholar
  56. Williams, R. B. (2000). Psychological factors, health, and disease: The impact of aging and the life cycle. In Manuck, S. B., Jennings, R., Rabin, B. S., and Baum, A. (Eds.), Behavior, health, and aging. Lawrence Earlbaum, Mahwah, NJ, pp. 135–151.Google Scholar
  57. World Health Organization. (1962). Arterial hypertension and ischemic heart disease: Preventive aspects (Technical Report Series 231). World Health Organization, Geneva, Switzerland.Google Scholar
  58. Zhang, J., Vitaliano, P. P., Scanlan, J. M., and Savage, M. (2000). Cardiovascular recovery interacts with chronic stress to predict cardiovascular disease incidence at a 5-year follow-up. Paper presented at the Society of Behavioral Medicine annual meeting, Nashville, TN.Google Scholar

Copyright information

© Springer Science+Business Media, Inc. 2005

Authors and Affiliations

  • Jianping Zhang
    • 1
    • 5
    Email author
  • Raymond Niaura
    • 2
  • John F. Todaro
    • 2
  • Jeanne M. McCaffery
    • 2
  • Biing-Jiun Shen
    • 2
  • Avron SpiroIII
    • 3
  • Kenneth D. Ward
    • 4
  1. 1.Department of PsychologyIndiana University – Purdue UniversityIndianapolisU.S.
  2. 2.Brown Medical School and the Miriam HospitalProvidenceRhode Island
  3. 3.Boston University School of Public Health and Boston VA Healthcare SystemBostonUSA
  4. 4.University of MemphisMemphisTennessee
  5. 5.Department of PsychologyIndiana University – Purdue University IndianapolisIndianapolisUSA

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