Anger has been implicated in the etiology of hypertensive disease. Trait anger has been linked to enhanced cardiovascular responsiveness. However, whether this association reflects differences in context appraisal or a general hyper-reactivity of the cardiovascular system remains unclear. We studied the cardiovascular response to acoustic startle probes in 76 healthy Caucasian males in different affective contices (pleasant, neutral, and unpleasant). All participants completed the State-Trait-Anger-Expression-Inventory (STAXI) by Spielberger and the results were analysed with stepwise regression analysis according to the anger scores and traditional risk factors for hypertension. Our study reveals differential modulation of the cardiovascular response to startle stimuli by affective pictures in the dimensions "valence" for heart rate and "arousal" for blood pressure. Anger-in was identified as the most important determinant for blood pressure responses in unpleasant context, while anger-out was associated with less cardiovascular activation in neutral context. This is the first study that relates trait anger to cardiovascular reactivity and affective reflex modulation in normotensive subjects. We could demonstrate an interaction of affective context and trait anger for cardiovascular (hyper-)reactivity. Increased cardiovascular reactivity for higher scores of anger-in in unpleasant context may indicate enhanced sympathetic reactivity and constitute a risk factor for the development of essential hypertension.
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