The purpose of this presentation is to provide a contemporary perspective on cardiovascular hyperreactivy associated with the affective state of anger and the personality trait of hostility. A data set will be used to illustrate the evaluation of anger and anger expression with the State-Trait Anger Expression Inventory. Current therapies useful in the facilitation of anger management and subsequent blood pressure reduction will also be presented. Anger and hostility have long been regarded as important factors in the etiology of hypertension and coronary heart disease. Affective states and personality traits such as anger and hostility are thought to predispose individuals to appraise and react to stimuli with rapid and prolong cardiovascular responses. Clinical research reviews have cited evidence of a stress-related hypersympathetic state in the early phases of essential hypertension. These individuals demonstrate signs of excessive cardiovascular drive as manifested by changes in cardiac output, heart rate, and pre-ejection period in response to mental challenge. Vulnerability to hypertension may be further determined by a lack of habituation of blood pressure reactivity to repeated cognitive challenge. From this perspective, lability of blood pressure parallels arousal of inner conflicts or emotions and functions as an antecedent of essential hypertension. The research literature on anger and hostility reveals a great deal of conceptual ambiguity. Progress in research on the role of anger and hostility in the etiology of essential hypertension and coronary heart disease urgently requires explicit distinction between the two concepts. Anger refers to an emotional reaction to a stressor. Individuals vary in the intensity of the reaction, the frequency with which anger is experience, and their manner of anger expression. In contrast, hostility is a personality trait composed of a complex set of attitudes that motivate aggressive behaviors. Identifying individuals, who are predisposed to anger or hostility, is critical to researchers and practitioners, if the high prevalence of hypertension is to be reduced. A number of valid, objective tools are available to assist in the evaluation of individuals who may be prone to anger and/or hostility. Prescribing appropriate therapies for the anger or hostility prone individual remains problematic, due to the inconsistent findings on the efficacy of such interventions.
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