Psychologic factors as precursors to hypertension

The possibility that certain psychologic factors lead to hypertension has been considered by many investigators over the past 60 years, but prospective studies with suitable methods to evaluate this hypothesis were not available for analysis until the 1990s. There are now five large longitudinal studies demonstrating a relation between symptoms of anxiety or depression and subsequent hypertension incidence. Anger expression, long considered a major psychologic factor in hypertension, has been studied less extensively, and the findings to date are less consistent. While some evidence supports the biological plausibility of psychologic factors as risk factors for hypertension, biobehavioral mechanisms explaining the relationship have not been adequately explored. The results of these recent studies may lead to new intervention trials specifically selecting hypertensive patients with anxiety or depression for treatment with stress reduction or other appropriate psychologic therapies. Such studies would further contribute to the evaluation of anxiety and depression as risk factors for hypertension.