弗明汉姆研究中高血压的心理预测因素。高血压中存在紧张情绪吗？

Psychological predictors of hypertension in the Framingham Study. Is there tension in hypertension?

作者信息

Markovitz J H, Matthews K A, Kannel W B, Cobb J L, D'Agostino R B

机构信息

Department of Medicine, University of Alabama School of Medicine, Birmingham 35205.

出版信息

JAMA. 1993 Nov 24;270(20):2439-43.

PMID:8230620

Abstract

OBJECTIVE

To test the hypothesis that heightened anxiety, heightened anger intensity, and suppressed expression of anger increase the risk of hypertension, using the Framingham Heart Study.

DESIGN

A cohort of men and women without evidence of hypertension at baseline were followed up for 18 to 20 years. Baseline measures of anxiety (tension), anger symptoms, and expression of anger (anger-in and anger-out) were taken, along with biological and behavioral predictors of hypertension (initial systolic blood pressure, heart rate, relative weight, age, hematocrit, alcohol intake, smoking, education, and glucose intolerance).

PARTICIPANTS

A total of 1123 initially normotensive persons (497 men, 626 women) were included. Analyses were stratified by age (45 to 59 or > or = 60 years) and gender.

MAIN OUTCOME MEASURES

Hypertension was defined as either taking medication for hypertension or blood pressures higher than 160/95 mm Hg at a biennial examination.

RESULTS

In univariate analyses, middle-aged men who went on to develop hypertension had greater baseline anxiety levels than men who remained normotensive (P = .04). Older hypertensive men had fewer anger symptoms at baseline (P = .04) and were less likely to hold their anger in (P = .01) than normotensives. In multivariate Cox regression analysis including biological predictors, anxiety remained an independent predictor of hypertension in middle-aged men (P = .02). Among older men, anger symptoms and anger-in did not remain significant predictors in the multivariate analysis. Further analysis showed that only middle-aged men with very high levels of anxiety were at increased risk (relative risk, 2.19; 95% confidence interval, 1.22 to 3.94). No psychological variable predicted hypertension in middle-aged or older women in either univariate or multivariate analyses.

CONCLUSIONS

The results indicate that among middle-aged men, but not women, anxiety levels are predictive of later incidence of hypertension.

摘要

目的

利用弗雷明汉心脏研究来检验以下假设，即焦虑加剧、愤怒强度增加以及愤怒表达受抑制会增加患高血压的风险。

设计

对一组基线时无高血压证据的男性和女性进行了18至20年的随访。采集了焦虑（紧张）、愤怒症状以及愤怒表达（内向愤怒和外向愤怒）的基线测量值，同时还采集了高血压的生物学和行为预测指标（初始收缩压、心率、相对体重、年龄、血细胞比容、酒精摄入量、吸烟情况、教育程度以及葡萄糖耐量异常）。

参与者

总共纳入了1123名最初血压正常的人（497名男性，626名女性）。分析按年龄（45至59岁或≥60岁）和性别进行分层。

主要观察指标

高血压定义为在两年一次的检查中正在服用抗高血压药物或血压高于160/95毫米汞柱。

结果

在单变量分析中，后来患高血压的中年男性基线焦虑水平高于血压仍正常的男性（P = 0.04）。老年高血压男性在基线时愤怒症状较少（P = 0.04），与血压正常者相比，他们抑制愤怒的可能性较小（P = 0.01）。在包括生物学预测指标的多变量Cox回归分析中，焦虑仍然是中年男性高血压的独立预测指标（P = 0.02）。在老年男性中，愤怒症状和内向愤怒在多变量分析中不再是显著的预测指标。进一步分析表明，只有焦虑水平非常高的中年男性风险增加（相对风险，2.19；95%置信区间，1.22至3.94）。在单变量或多变量分析中，没有心理变量能预测中年或老年女性的高血压。