Articles
31 July 2025
Online Advance Publication
Impact of personality traits, coping styles, and anger on psychological symptoms of patients with arterial hypertension
Psychological factors in arterial hypertension
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
579
Views
234
Downloads
Authors
This observational study aimed to investigate the interplay between psychological factors in clinical and non-clinical groups of patients with arterial hypertension. Specifically, the main objectives were: i) to examine associations between personality traits, anger, and psychological symptoms; ii) to explore how coping styles interact with anger in modulating distress; and iii) to compare patients with and without significant psychological distress. One hundred hypertensive patients (mean age 56.04±12.04) were consecutively recruited. Psychological symptoms, anger dimensions, personality traits, and coping strategies were assessed through the Symptom Checklist-90- Revised (SCL-90-R), the State-Trait Anger Expression Inventory-2 (STAXI-2), the 16 Personality Factors Questionnaire (16PF), and the Coping Orientation to Problems Experienced (COPE), respectively. The Global Severity Index (GSI) of the SCL-90-R was used to differentiate a clinical group (T-score≥63) from a non-clinical one. In the overall sample, specific personality traits predicted anxiety, somatization, and paranoid ideation. Symptoms such as psychoticism and hostility were linked to poor anger regulation, and the expression of anger was associated with avoidance-based coping. Patients with higher levels of psychological distress (49% of the patients) were more introverted and emotionally unstable, with symptoms predicted by low liveliness and high rule-consciousness. In contrast, anger expression and control emerged as key modulators of subclinical symptoms even in the non-clinical group (51% of the sample). The integrative and comparative nature of the study described different relationships between personality, anger management, and psychological symptoms between groups of hypertensive patients, divided according to the severity of psychological distress. Additionally, even sub-threshold symptoms proved to be shaped by patterns of emotional regulation, underscoring the need to integrate psychological assessments in the treatment of hypertension.
Altmetrics
Downloads
Download data is not yet available.
Citations
Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical Psychology Review, 30(2), 217–237. doi: 10.1016/j.cpr.2009.11.004 DOI: https://doi.org/10.1016/j.cpr.2009.11.004
Apgáua, L. T., & Jaeger, A. (2019). Memory for emotional information and alexithymia A systematic review. Dementia & Neuropsychologia, 13(1), 22–30. doi: 10.1590/1980-57642018dn13-010003 DOI: https://doi.org/10.1590/1980-57642018dn13-010003
Bonaguidi, F., Michelassi, C., Trivella, M. G., Carpeggiani, C., Pruneti, C. A., Cesana, G., & L'Abbate, A. (1996). Cattell's 16 PF and PSY inventory: relationship between personality traits and behavioral responses in patients with acute myocardial infarction. Psychological Reports, 78(2), 691–702. doi: 10.2466/pr0.1996.78.2.691 DOI: https://doi.org/10.2466/pr0.1996.78.2.691
Celano, C. M., Villegas, A. C., Albanese, A. M., Gaggin, H. K., & Huffman, J. C. (2018). Depression and Anxiety in Heart Failure: A Review. Harvard Review of Psychiatry, 26(4), 175–184. doi: 10.1097/HRP.0000000000000162 DOI: https://doi.org/10.1097/HRP.0000000000000162
Chida, Y., & Steptoe, A. (2009). The association of anger and hostility with future coronary heart disease: a meta-analytic review of prospective evidence. Journal of the American College of Cardiology, 53(11), 936–946. doi: 10.1016/j.jacc.2008.11.044 DOI: https://doi.org/10.1016/j.jacc.2008.11.044
Colivicchi, F., Abrignani, M. G., & Santini, M. (2010). Aderenza terapeutica: il fattore di rischio occulto [Therapeutic non-adherence: the hidden risk factor]. Giornale Italiano di Cardiologia (2006), 11(5 Suppl 3), 124S–127S.
Davidson, K. W., & Mostofsky, E. (2010). Anger expression and risk of coronary heart disease: evidence from the Nova Scotia Health Survey. American Heart Journal, 159(2), 199–206. doi: 10.1016/j.ahj.2009.11.007 DOI: https://doi.org/10.1016/j.ahj.2009.11.007
Denollet, J., Martens, E. J., Nyklícek, I., Conraads, V. M., & de Gelder, B. (2008). Clinical events in coronary patients who report low distress: adverse effect of repressive coping. Health psychology: official journal of the Division of Health Psychology, American Psychological Association, 27(3), 302–308. doi: 10.1037/0278-6133.27.3.302 DOI: https://doi.org/10.1037/0278-6133.27.3.302
Derogatis, L.R. (1994). SCL-90-R: Administration, Scoring and Procedures Manual. National Computer Systems.
GBD 2017 Risk Factor Collaborators (2018). Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet (London, England), 392(10159), 1923–1994. doi: 10.1016/S0140-6736(18)32225-6 DOI: https://doi.org/10.1016/S0140-6736(18)32225-6
Gullo, S., Gelo, O. C. G., Bassi, G., Lo Coco, G., Lagetto, G., Esposito, G., Pazzagli, C., Salcuni, S., Freda, M. F., Mazzeschi, C., Giordano, C., & Di Blasi, M. (2022). The role of emotion regulation and intolerance to uncertainty on the relationship between fear of COVID-19 and distress. Current Psychology, 42(23), 19658-19669. doi: 10.1007/s12144-022-03071-5 DOI: https://doi.org/10.1007/s12144-022-03071-5
Hamam, M. S., Kunjummen, E., Hussain, M. S., Nasereldin, M., Bennett, S., & Miller, J. (2020). Anxiety, Depression, and Pain: Considerations in the Treatment of Patients with Uncontrolled Hypertension. Current Hypertension Reports, 22(12), 106. doi: 10.1007/s11906-020-01117-2 DOI: https://doi.org/10.1007/s11906-020-01117-2
Hernandez, D. H., Larkin, K. T., & Whited, M. C. (2009). Cardiovascular response to interpersonal provocation and mental arithmetic among high and low hostile young adult males. Applied Psychophysiology and Biofeedback, 34(1), 27–35. doi: 10.1007/s10484-009-9076-3 DOI: https://doi.org/10.1007/s10484-009-9076-3
Khayyam-Nekouei, Z., Neshatdoost, H., Yousefy, A., Sadeghi, M., & Manshaee, G. (2013). Psychological factors and coronary heart disease. ARYA Atherosclerosis, 9(1), 102–111.
Kim, A. S., Jang, M. H., Park, K. H., & Min, J. Y. (2020). Effects of Self-Efficacy, Depression, and Anger on Health-Promoting Behaviors of Korean Elderly Women with Hypertension. International Journal of Environmental Research and Public Health, 17(17), 6296. doi: 10.3390/ijerph17176296 DOI: https://doi.org/10.3390/ijerph17176296
Kline, K. A., Fekete, E. M., & Sears, C. M. (2008). Hostility, emotional expression, and hemodynamic responses to laboratory stressors: reactivity attenuating effects of a tendency to express emotion interpersonally. International Journal of Psychophysiology: Official Journal of the International Organization of Psychophysiology, 68(3), 177–185. doi: 10.1016/j.ijpsycho.2008.01.005 DOI: https://doi.org/10.1016/j.ijpsycho.2008.01.005
Kretchy, I. A., Owusu-Daaku, F. T., & Danquah, S. A. (2014). Mental health in hypertension: assessing symptoms of anxiety, depression and stress on anti-hypertensive medication adherence. International Journal of Mental Health Systems, 8, 25. doi: 10.1186/1752-4458-8-25 DOI: https://doi.org/10.1186/1752-4458-8-25
Kupper, N., & Denollet, J. (2018). Type D Personality as a Risk Factor in Coronary Heart Disease: a Review of Current Evidence. Current Cardiology Reports, 20(11), 104. doi: 10.1007/s11886-018-1048-x DOI: https://doi.org/10.1007/s11886-018-1048-x
Lambert, E., Dawood, T., Straznicky, N., Sari, C., Schlaich, M., Esler, M., & Lambert, G. (2010). Association between the sympathetic firing pattern and anxiety level in patients with the metabolic syndrome and elevated blood pressure. Journal of Hypertension, 28(3), 543–550. doi: 10.1097/HJH.0b013e3283350ea4 DOI: https://doi.org/10.1097/HJH.0b013e3283350ea4
Lee, J. H., Kim, K. I., & Cho, M. C. (2019). Current status and therapeutic considerations of hypertension in the elderly. The Korean Journal of Internal Medicine, 34(4), 687–695. doi: 10.3904/kjim.2019.196 DOI: https://doi.org/10.3904/kjim.2019.196
Mahmood, A., Simon, J., Cooper, J., Murphy, T., McCracken, C., Quiroz, J., Laranjo, L., Aung, N., Lee, A. M., Khanji, M. Y., Neubauer, S., Raisi-Estabragh, Z., Maurovich-Horvat, P., & Petersen, S. E. (2023). Neuroticism personality traits are linked to adverse cardiovascular phenotypes in the UK Biobank. European heart journal. Cardiovascular Imaging, 24(11), 1460–1467. doi: 10.1093/ehjci/jead166 DOI: https://doi.org/10.1093/ehjci/jead166
Meuret, A. E., Kroll, J., & Ritz, T. (2017). Panic Disorder Comorbidity with Medical Conditions and Treatment Implications. Annual Review of Clinical Psychology, 13, 209–240. doi: 10.1146/annurev-clinpsy-021815-093044 DOI: https://doi.org/10.1146/annurev-clinpsy-021815-093044
Nabi, H., Kivimäki, M., Zins, M., Elovainio, M., Consoli, S. M., Cordier, S., Ducimetière, P., Goldberg, M., & Singh-Manoux, A. (2008). Does personality predict mortality? Results from the GAZEL French prospective cohort study. International Journal of Epidemiology, 37(2), 386–396. doi: 10.1093/ije/dyn013 DOI: https://doi.org/10.1093/ije/dyn013
Nicholson, A., Kuper, H., & Hemingway, H. (2006). Depression as an aetiologic and prognostic factor in coronary heart disease: a meta-analysis of 6362 events among 146 538 participants in 54 observational studies. European Heart Journal, 27(23), 2763–2774. doi: 10.1093/eurheartj/ehl338 DOI: https://doi.org/10.1093/eurheartj/ehl338
Oliva, F., Versino, E., Gammino, L., Colombi, N., Ostacoli, L., Carletto, S., Furlan, P. M., & Picci, R. L. (2016). Type D Personality and Essential Hypertension in Primary Care: A Cross-Sectional Observational Study Within a Cohort of Patients Visiting General Practitioners. The Journal of Nervous and Mental Disease, 204(1), 43–48. doi: 10.1097/NMD.0000000000000421 DOI: https://doi.org/10.1097/NMD.0000000000000421
Özpelit, M. E., Özpelit, E., Doğan, N. B., Pekel, N., Ozyurtlu, F., Yılmaz, A., Saygı, S., Tengiz, İ., & Ercan, E. (2015). Impact of anxiety level on circadian rhythm of blood pressure in hypertensive patients. International Journal of Clinical and Experimental Medicine, 8(9), 16252–16258.
Penley, J. A., Tomaka, J., & Wiebe, J. S. (2002). The association of coping to physical and psychological health outcomes: a meta-analytic review. Journal of Behavioral Medicine, 25(6), 551–603. doi: 10.1023/a:1020641400589 DOI: https://doi.org/10.1023/A:1020641400589
Player, M. S., Mainous, A. G., 3rd, & Carnemolla, M. (2008). Anxiety and unrecognized high blood pressure in U.S. ambulatory care settings: an analysis of the 2005 National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. International Journal of Psychiatry in Medicine, 38(1), 91–101. doi: 10.2190/PM.38.1.i DOI: https://doi.org/10.2190/PM.38.1.i
Quinto, R. M., De Vincenzo, F., Graceffa, D., Bonifati, C., Innamorati, M., & Iani, L. (2022). The Relationship between Alexithymia and Mental Health Is Fully Mediated by Anxiety and Depression in Patients with Psoriasis. International Journal of Environmental Research and Public Health, 19(6), 3649. doi: 10.3390/ijerph19063649 DOI: https://doi.org/10.3390/ijerph19063649
Riaz, M., Shah, G., Asif, M., Shah, A., Adhikari, K., & Abu-Shaheen, A. (2021). Factors associated with hypertension in Pakistan: A systematic review and meta-analysis. PloS one, 16(1), e0246085. doi: 10.1371/journal.pone.0246085 DOI: https://doi.org/10.1371/journal.pone.0246085
Roest, A. M., Martens, E. J., de Jonge, P., & Denollet, J. (2010). Anxiety and risk of incident coronary heart disease: a meta-analysis. Journal of the American College of Cardiology, 56(1), 38–46. doi: 10.1016/j.jacc.2010.03.034 DOI: https://doi.org/10.1016/j.jacc.2010.03.034
Rosendorff, C., Black, H. R., Cannon, C. P., Gersh, B. J., Gore, J., Izzo, J. L., Jr, Kaplan, N. M., O'Connor, C. M., O'Gara, P. T., Oparil, S., American Heart Association Council for High Blood Pressure Research, American Heart Association Council on Clinical Cardiology, & American Heart Association Council on Epidemiology and Prevention (2007). Treatment of hypertension in the prevention and management of ischemic heart disease: a scientific statement from the American Heart Association Council for High Blood Pressure Research and the Councils on Clinical Cardiology and Epidemiology and Prevention. Circulation, 115(21), 2761–2788. doi: 10.1161/CIRCULATIONAHA.107.183885 DOI: https://doi.org/10.1161/CIRCULATIONAHA.107.183885
Sarafidis, P. A., Li, S., Chen, S. C., Collins, A. J., Brown, W. W., Klag, M. J., & Bakris, G. L. (2008). Hypertension awareness, treatment, and control in chronic kidney disease. The American Journal of Medicine, 121(4), 332–340. doi: 10.1016/j.amjmed.2007.11.025 DOI: https://doi.org/10.1016/j.amjmed.2007.11.025
Sica, C., Magni, C., Ghisi, M., Altoè, G., Sighinolfi, C., Chiria, L.R., & Franceschini, S. (2008). Coping Orientation to Problems Experienced - Nuova Versione Italiana (COPE-NVI): uno strumento per la misura degli stili di coping. Psicoterapia Cognitiva e Comportamentale, 14(1): 27-53.
Sirigatti, S., & Stefanile, C. (2001). Il 16PF-5 adattamento italiano. OS Organizzazioni Speciali.
Spielberger, C.D. (2004). State-Trait Anger Expression Inventory-2 (STAXI-2). Giunti O.S.
Spira, A. P., Zvolensky, M. J., Eifert, G. H., & Feldner, M. T. (2004). Avoidance-oriented coping as a predictor of panic-related distress: a test using biological challenge. Journal of Anxiety Disorders, 18(3), 309–323. doi: 10.1016/S0887-6185(02)00249-9 DOI: https://doi.org/10.1016/S0887-6185(02)00249-9
Suls, J., & Bunde, J. (2005). Anger, anxiety, and depression as risk factors for cardiovascular disease: the problems and implications of overlapping affective dispositions. Psychological Bulletin, 131(2), 260–300. doi: 10.1037/0033-2909.131.2.260 DOI: https://doi.org/10.1037/0033-2909.131.2.260
Tremblay, M. A., Denis, I., Turcotte, S., DeGrâce, M., Tully, P. J., & Foldes-Busque, G. (2023). Cognitive-Behavioral Therapy for Panic Disorder in Patients with Stable Coronary Artery Disease: A Feasibility Study. Journal of Clinical Psychology in Medical Settings, 30(1), 28–42. doi: 10.1007/s10880-022-09876-7 DOI: https://doi.org/10.1007/s10880-022-09876-7
Williams, R. B., Jr, Haney, T. L., Lee, K. L., Kong, Y. H., Blumenthal, J. A., & Whalen, R. E. (1980). Type A behavior, hostility, and coronary atherosclerosis. Psychosomatic Medicine, 42(6), 539–549. doi: 10.1097/00006842-198011000-00002 DOI: https://doi.org/10.1097/00006842-198011000-00002
Supporting Agencies
The research was conducted with a grant for a doctoral project whose scholarship was funded by the Puglia Region - European Social Fund for research in the field of hospital psychology - connection between universities and research institutions in the healthcare system on quality of life and multidisciplinary approach to the treatment system in cardiological rehabilitation.How to Cite
Impact of personality traits, coping styles, and anger on psychological symptoms of patients with arterial hypertension: Psychological factors in arterial hypertension. (2025). Research in Psychotherapy: Psychopathology, Process and Outcome. https://doi.org/10.4081/ripppo.2025.867
Copyright (c) 2025 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.