| Summary: | The exact nature of the anger - cardiovascular health relationship and its mechanisms remain obscure,
partly due to controversy over the conceptualization and measurement of anger. Reliance on an oversimplified
model of anger may have hindered comprehensive understanding of its pathogenic effects.
Using a multi-dimensional anger response measure (Behavioural Anger Response Questionnaire; BARQ)
that taps six independent anger response styles (Aggression, Assertion, Social Support Seeking,
Diffusion, Avoidance, and Rumination) and data from three samples of varying cardiovascular health
status [healthy participants, hypertensive, and coronary heart disease (CHD) patients], the relation of
anger coping styles to resting blood pressure (BP), ambulatory BP, BP reactivity and recovery was
investigated. Linear, curvilinear, and interactive relationships were tested, controlling for traditional risk
factors and level of hostility. Examination of linear effects revealed inconsistent associations between
anger response styles and BP. The strongest effects were for Avoidance and Rumination; in the women,
Avoidance was linked with higher BP levels, and in the men, Rumination was associated with lower BP
levels. Examination of curvilinear relationships revealed surprising results. The clearest pattern was
observed for Aggression; increasingly higher levels of Aggression were associated with higher BP levels,
but this association reversed for those with the highest levels of Aggression. The moderating effect of
Rumination on the relationship between the other anger response styles and BP was also examined.
Rumination had a deleterious influence on the relationship between Avoidance and Assertion and resting
and ambulatory BP levels. The moderating influence of Rumination on Social Support Seeking varied
between the genders. Anger response styles also predicted BP reactivity and recovery. Overall, the
results suggest that a multi-dimensional model of anger responding is valuable and that anger response
styles are related to BP variables in complex ways.
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