title: The relation of anger expression with blood pressure levels and hypertension in rural and urban Japanese communities.
abstract: OBJECTIVE
  To examine the relation of anger expression with blood pressure and hypertension among Japanese.
  
  
  METHODS
  A cross-sectional study.
  
  
  METHODS
  Subjects were 4374 men and women aged 30-74 years from rural and urban communities. Anger expression was estimated using the anger-out and anger-in scores of the Spielberger Anger Expression Scale. Multiple linear regression analyses were performed to estimate the associations of anger expression scores with blood pressure. Proportions of hypertensives among the tertiles of anger expression scores and the relative odds of hypertension for low versus high tertiles of anger expression scales were calculated using logistic regression models.
  
  
  RESULTS
  The anger-out score was inversely associated with systolic and diastolic blood pressure levels for men; a four-point (one standard deviation) lower anger-out score was associated with 1.6 mmHg [95% confidence interval (CI), 0.6-2.6] greater systolic blood pressure and 0.6 mmHg (95% CI, -0.03 to 1.2) greater diastolic pressure after adjustment for age, body mass index, alcohol intake, smoking category, and parental history of hypertension. The adjusted relative odds of hypertension for low versus high tertiles of anger-out was 1.60 (95% CI, 1.19-2.15). These inverse associations were more evident among men with low coping behavior than among those with high coping behavior. For women, the anger-out score was not associated with blood pressure. There was no relation between the anger-in score and either blood pressure or hypertension in either men or women.
  
  
  CONCLUSIONS
  This study suggests that Japanese men who do not express their anger, especially when they have low coping behavior, may have an increased risk of high blood pressure.
authors.affiliation: Institute of Community Medicine, University of Tsukuba, Tsukuba-shi, Ibaraki-ken, Japan. teoohira-circ@umin.ac.jp
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Ohira
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Iso
authors.forename: Takeshi
authors.initials: T
authors.lastname: Tanigawa
authors.forename: Tomoko
authors.initials: T
authors.lastname: Sankai
authors.forename: Hironori
authors.initials: H
authors.lastname: Imano
authors.forename: Masahiko
authors.initials: M
authors.lastname: Kiyama
authors.forename: Shinichi
authors.initials: S
authors.lastname: Sato
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Naito
authors.forename: Minoru
authors.initials: M
authors.lastname: Iida
authors.forename: Takashi
authors.initials: T
authors.lastname: Shimamoto
mesh_terms: D000328:Adult; D000368:Aged; D000786:Anger / Q000502:physiology*; D001794:Blood Pressure / Q000502:physiology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000503:physiopathology*; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D012423:Rural Health; D012424:Rural Population; D012737:Sex Factors; D013223:Statistics as Topic; D014504:Urban Health