Anger-in, anger-out, and hostility: Associations with clinic and ambulatory blood pressure in a biracial sample of normotensive and hypertensive males and females

Date of Award




Degree Name

Doctor of Philosophy (Ph.D.)



First Committee Member

Patrice G. Saab - Committee Chair


The relationships between the anger suppression (AX/In) and anger expression (Ax/Out) subscales of the Anger Expression Scale, the Cook-Medley Hostility (Ho) Scale, the Marlowe-Crowne Social Desirability Scale (MC), and blood pressure (BP) were examined in 161 normotensive and mildly hypertensive Black and White males and females. Systolic and diastolic blood pressure (SBP and DBP) were assessed in a clinic setting and, via ambulatory monitoring, at home and at work.The relationships among the psychosocial variables (Ax/In, Ax/Out, Ho, and MC) and between the demographic and psychosocial variables differed between the race by gender groups. The demographic predictors of BP varied between groups and between settings. Parental history of hypertension (HX) appeared to be a stronger predictor of BP for females than for males and to be more strongly related to ambulatory BP than to clinic BP.Multiple regression analyses were used to test the effects of anger/hostility scores adjusted for the effects of defensiveness on BP. After controlling for age, BMI, and HX, adjusted AX/In was negatively related to work in females and to clinic BP in Black males and was positively related to clinic BP in Black females. Adjusted Ax/Out and adjusted Ho were unrelated to BP in males and females. Post-hoc analyses indicated that adjusted Ho accounted for an additional 4% of the variance in home DBP for all subjects. There were trends for Marlowe-Crowne scores to add to the prediction of BP in males but not in females. The relationships to BP differed between adjusted and unadjusted scores for Ho but not for AX.The results show that gender and race are important determinants of the relationship of anger-coping to BP. Anger suppression can be associated with either increased or decreased BP, and it appears that the effects of anger coping are determined by a complex set of factors. The results support cardiovascular reactivity as a link between hostility and cardiovascular disease and also suggest that ambulatory BP reflects reactivity. Defensiveness moderates the relationship between Ho and BP but not between AX/In and BP.


Psychology, Clinical; Psychology, Physiological

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