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Tension and Hypertension

Thomas G. Pickering, MD, DPhil
JAMA. 1993;270(20):2494. doi:10.1001/jama.1993.03510200100039.
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Many patients with high blood pressure consider that the term hypertension refers to an elevation of nervous as well as physical tension, an idea first proposed in 1905 by Gaisböck, who observed that in men with high systolic pressure "one finds an unusual frequency of those who as directors of big enterprises had a great deal of responsibility and who, after long periods of psychic overwork, became nervous."1 Many physicians, on the other hand, doubt that mental factors play any significant role in the development of hypertension. The study by Markovitz et al2 in this issue of THE JOURNAL offers support for the patients' viewpoint. The concept of a "hypertensive personality" has been debated for about 50 years, but there is still no consensus as to whether it really exists or, if it does, how it should be defined or measured.

Three views have been advocated: first, that


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