ابراز خشم و فشار خون بالا ضروری پاسخ رفتاری برای رویارویی

Objective The purpose of this study was to examine the range of anger-expressive behaviors and social competencies among essential hypertensive patients. Methods Behavioral reactions to both neutral and anger-evoking role-play interactions were measured in 26 hypertensive and 15 normotensive patients. Social behaviors were assessed using self-report measures of anger expression, assertiveness, self- and other-ratings of social competence and behavioral measures of anger expression observed during role-play interactions. Results Hypertensive patients showed less eye contact, used fewer positive assertive statements and were rated as being less assertive during confrontational role-play scenarios than normotensive controls. Hypertensive patients also exhibited higher pulse pressure reactions to confrontation than normotensives, particularly hypertensive patients who expressed anger overtly. Conclusion Essential hypertension is associated with specific social skill deficits that are only apparent during the assertive expression of anger.

Since Alexander [1] first postulated psychosomatic explanations for medical problems, the psychological construct of “suppressed hostility” has been associated with the condition of essential hypertension. Because measurement of intrapsychic phenomenon like suppressed hostility has proven difficult, most empirical work in this area has focused upon the behavioral expression of anger or assertiveness (see [2] and [3]). “Suppressed hostility” is typically inferred when individuals display submissive or less aggressive social behaviors in confrontational or anger-provoking situations. The direction of the relation between anger expression and essential hypertension, however, has not been clear. In some investigations, patients with essential hypertension have exhibited fewer aggressive and more submissive behaviors than nonhypertensive patients (e.g., [4] and [5]), and in other studies, hypertensives have displayed more aggressive behaviors than normotensives (e.g., [6] and [7]). Mixed findings of this nature led Harburg et al. [8] to suggest that both “inappropriate submissiveness” and “inappropriate assertiveness” may play a role in hypertension, depending on situational (e.g., current stressors) and individual factors (e.g., age) (p. 199). This curvilinear hypothesis has led several researchers to examine whether overly submissive hypertensive patients represented a different form of essential hypertension than overly aggressive hypertensive patients (e.g., [9] and [10]). In particular, it was hypothesized that these two behavioral patterns may be associated with distinct physiological profiles that contributed to elevations in blood pressure. For example, Esler et al. [9] found that high-renin hypertensives exhibited more submissive behaviors consistent with “suppressed hostility” compared to low-renin hypertensives and normotensive controls. Morrison et al. [10] suggested that hypertensive patients' style of anger expression may be associated with distinct patterns of cardiovascular reactivity to stress. They found that hypertensives characterized by large pulse pressure reactions during confrontation (suggestive of greater myocardial responses) exhibited significantly more overt aggressive behaviors during a role-play interaction relative to normotensives and low pulse pressure reactive hypertensives. Hypertensive patients who showed low pulse pressure reactions to confrontation (suggesting a greater contribution of peripheral vascular resistance to their cardiovascular reactions) were rated as more submissive during role-play interactions than either high pulse pressure reactive hypertensives or normotensive controls. These findings supported the contention that essential hypertensive patients constitute a heterogeneous population consisting of subgroups of patients who differ in both their behavioral and psychophysiological responses during confrontation. The purpose of the present investigation was to further explore the relation between anger expression and hypertensive status. In addition, this study addressed whether cardiovascular reactivity during confrontation among hypertensive patients corresponded to predictable patterns of behavioral expression of anger during confrontational role-play interactions. Behavioral responses of hypertensive patients were compared with normotensive control subjects during both neutral and confrontational interpersonal interactions; self- and other-reported measures of social competence were also measured. We hypothesized that hypertensive patients would exhibit less assertive behavior and social competence than their normotensive counterparts. We expected that these differences would be more apparent during the confrontational interpersonal interactions that encouraged the expression of anger than the neutral interpersonal interactions.