Although psychosocial factors are correlated, previous studies on risk
factors for hypertension have typically examined psychosocial factors individually
and have yielded inconsistent findings.
To examine the role of psychosocial factors of time urgency/impatience
(TUI), achievement striving/competitiveness (ASC), hostility, depression,
and anxiety on long-term risk of hypertension.
Design, Setting, and Study Population
A population-based, prospective, observational study using participant
data from the Coronary Artery Risk Development in Young Adults (CARDIA) study.
A total of 3308 black and white adults aged 18 to 30 years (when recruited
in 1985 and 1986) from 4 US metropolitan areas and followed up through 2000
Main Outcome Measures
Fifteen-year cumulative incidence of hypertension (systolic blood pressure
of 140 mm Hg or higher, diastolic blood pressure of 90 mm Hg or higher, or
taking antihypertensive medication).
The incidence of hypertension at year 15 was 15% from baseline and 13.6%
from year 5. After adjusting for the same set of hypertension risk factors
and each of the psychosocial factors of TUI, ASC, hostility, depression, and
anxiety in 5 separate logistic regression models, higher TUI and hostility
were significantly associated with risk of developing hypertension at 15-year
follow-up for the total sample. Compared with the lowest score group, the
adjusted odds ratio (OR) for TUI was 1.51 (95% confidence interval [CI], 1.12-2.03)
for a score of 1; 1.47 (95% CI, 1.08-2.02) for a score of 2; and 1.84 (95%
CI, 1.29-2.62) for a score of 3 to 4 (P for trend
= .001). Compared with the lowest quartile group, the adjusted OR for hostility
was 1.06 (95% CI, 0.76-1.47) for quartile 2; 1.38 (95% CI, 1.00-1.91) for
quartile 3; and 1.84 (95% CI, 1.33-2.54) for quartile 4 (P for trend <.001). No consistent patterns were found for ASC, depression,
or anxiety. Race- and sex-specific analyses and multivariable models with
simultaneous adjustment for all 5 psychosocial factors and other hypertension
risk factors had generally similar results.
Among young adults, TUI and hostility were associated with a dose-response
increase in the long-term risk of hypertension.