Young adults with marked hostility or sense of time urgency or impatience are at higher risk of developing hypertension as they age, according to an article in the October 22nd issue of The Journal of the American Medical Association.

According to background information in the article, individual psychosocial factors such as the type A behavior pattern (namely, time urgency/impatience, achievement striving/competitiveness, hostility), depression, and anxiety have been linked with hypertension, although study results have been inconsistent.

Lijing L. Yan, Ph.D., M.P.H., and his American colleagues investigated the relationships of the three main components of the type A behavior pattern---hostility, time urgency or impatience, and achievement striving or competitiveness---and two other major psychosocial factors, depression and anxiety, with long-term risk for hypertension. The researchers used data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, which included 3,308 adults aged 18 to 30 years at baseline in 1985 and 1986 and followed through 2000 to 2001, with assessments taken for psychosocial factors and hypertension.

"In this cohort of white and black young adults, we found that time urgency/impatience and hostility assessed during young adulthood were associated in a dose-response manner with a higher risk of developing hypertension 15 years later. These associations were independent of age, sex, race, baseline systolic blood pressure, education, body mass index, daily alcohol consumption, and level of physical activity," the authors wrote. "With the exception of white men, no consistent relationship was observed between achievement striving/competitiveness and 15-year risk of hypertension and between depression or anxiety and 10-year risk of hypertension."

The authors concluded, "Also needed is the development of effective strategies for recognizing, modifying, alleviating, and managing harmful psychosocial tendencies. Successful implementation of these strategies at the personal, clinical, and community level could have important implications for prevention and management of hypertension and cardiovascular disease."

In an accompanying editorial, Redford B. Williams, M.D., John C. Barefoot, Ph.D., and Neil Schneiderman, Ph.D., wrote that much more work will be required before behavioral treatments to reduce the harmful effects of psychosocial risk factors are standard practice.

"The current state of affairs regarding behavioral interventions targeting psychosocial risk factors may be similar to that surrounding the use of beta-blocker therapy in the 1970s for patients who had a myocardial infarction: some clinical trials showed a benefit, but others did not. It was not until data were available from the Beta-Blocker Heart Attack Trial and pooled analyses of multiple trials that it became clear that highly reliable reductions of 23 percent to 28 percent in various clinical end points were obtained. Now beta-blocker therapy is standard therapy following a myocardial infarction."

"The study by Yan et al, showing that psychosocial risk factors increase risk of cardiovascular disease, the current evidence regarding biologically plausible mechanisms that are likely to mediate associations between psychosocial risk factors and cardiovascular disease risk, and the evidence from clinical trials of behavioral and pharmacological treatments targeting psychosocial factors support the need for increased research to develop, implement, and test behavioral and pharmacological interventions aimed at reducing the impact of psychosocial factors on the development and prognosis of cardiovascular disease. As the state of knowledge continues to expand, it will be important to include assessment of genetic factors that may moderate the impact of such interventions as well as the biobehavioral mechanisms that mediate their benefits," they concluded.