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Personality, coronary-prone behaviour and adrenergic factors in essential hypertension: possible implications for
Insights
High blood pressure patients with high renin activity exhibit suppressed anger and chronic frustration, suggesting a
Area of Science:
- Cardiology
- Psychophysiology
- Hypertension Research
Background:
- High blood pressure and the coronary-prone (Type A) behavior pattern are established risk factors for myocardial infarction and sudden cardiac death.
- Previous research suggested links via sympathetic nervous system mechanisms, but Type A scores were often low in hypertensive individuals.
- Psychodynamic assessments revealed different aggression patterns in hypertensive patients compared to Type A behavior scores.
Purpose of the Study:
- To investigate the relationship between personality profiles, biochemical markers of sympathetic activity, and hypertension.
- To explore the psychophysiological mechanisms underlying hypertension and coronary heart disease risk.
- To identify potential personality traits associated with high renin activity in hypertensive patients.
Main Methods:
- Assessed psychodynamic personality profiles and Type A behavior.
- Related these assessments to biochemical markers, including plasma noradrenaline and renin activity.
- Utilized projective assessments of frustration reactions during everyday stress.
Main Results:
- Hypertensive patients with high plasma renin activity and high noradrenaline showed internalized aggression, submissiveness, and a need for immediate conflict resolution.
- These traits lead to chronic frustration, a characteristic also observed in patients at risk for coronary heart disease.
- High renin patients demonstrated a higher incidence of critical cardiac events.
Conclusions:
- A 'hypertensive coronary-prone personality' characterized by suppressed anger and chronic frustration may exist.
- High renin activity in hypertensive patients is linked to specific psychological stress responses.
- High renin patients may benefit significantly from beta-blocker therapy due to their antihypertensive response and potential cardioprotective effects.
Abstract:
An association between high blood pressure and the coronary-prone (or type A) behaviour pattern, established as risk factors for myocardial infarction and sudden death, has been postulated on the basis of similar psychophysiological mechanisms involving the sympathetic nervous system. Psychodynamic personality profiles and type A behaviour assessment have therefore been related to biochemical markers of sympathetic overactivity, but type A behaviour scores were generally found to be low in hypertensive subjects - and lowest in those with high plasma noradrenaline. However, projective assessment of reactions to frustration during everyday stress indicates that hypertensive patients with high plasma renin activity as well as high noradrenaline have less externalized but more internalized aggression, and are submissive yet have a stronger need to resolve conflicts immediately. These incompatible tendencies result in chronic frustration. A similar high degree of suppressed anger is shared by patients at risk for coronary heart disease, and high renin patients have a higher incidence of critical cardiac events. This suggests the possibility of a 'hypertensive coronary-prone personality'. Because of their excellent antihypertensive response to chronic beta-blocker therapy, it is conceivable that high renin patients benefit most from the cardioprotective potential of beta-blocker-based antihypertensive therapy.