Anger and cardiovascular startle reactivity in normotensive young males Steffen Richter a, ⁎, Hans-Christian Deter b , Miriam Rudat b , Hartmut Schächinger a , Frank Zimmermann-Viehoff b , Cora Weber b a University of Trier, Institute of Psychobiology, Department of Clinical Physiology, Trier, Germany b Department of Psychosomatic Medicine and Psychotherapy, Charité Universitätsmedizin, Campus Benjamin Franklin, Berlin, Germany abstract article info Article history: Received 18 June 2010 Received in revised form 13 December 2010 Accepted 15 December 2010 Available online 22 December 2010 Keywords: Anger Startle reflex Cardiovascular reactivity Affective modulation 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. © 2010 Elsevier B.V. All rights reserved. 1. Introduction The prevalence of hypertension has been rising continuously in modern society. The contribution of psychosocial factors such as suppressed anger has been suggested early in hypertension research (Alexander, 1939). Anger has repeatedly been linked with the etiology of essential hypertension (Deter et al., 2001; Dimsdale et al., 1986). A recent review found a consistent association of trait anger and ambulatory blood pressure (Schum et al., 2003). It has been hypothesized that trait anger causes increased physiological arousal by interacting with situational factors (Jorgensen et al., 1996). In line with this, trait anger has been linked to enhanced cardiovascular reactivity (Bongard et al., 1998; Vogele et al., 1997) and increased sympathetic activity (McCraty et al., 1995). Indeed, a functional blood pressure rise in stressful situations can precede a permanently elevated blood pressure that is solidified by structural changes of the arteries (Schlaich et al., 2004). Furthermore, enhanced sympa- thetic activity can promote later hypertension without preceding blood pressure elevations. Enhanced sympathetic activity unfolds deleterious effects on the cardiovascular system (Mancia et al., 1999), promoting media sclerosis and heightened vascular resistance (Ferriss, 1978; Markovitz et al., 1993). However, little is known about the affective modulation of blood pressure responsiveness and the relationship between anger and cardiovascular reactivity in a healthy population. Especially “anger- in”, i.e. anger directed towards the own person, held or suppressed anger feelings, and “anger out”, i.e. overtly and directly expressed anger towards other persons or environmental objects (Forgays et al., 1997) appear to be positively correlated with resting systolic blood pressure (Bongard and al'Absi, 2005; Igna et al., 2009; Vogele and Steptoe, 1992). Negative correlations with resting diastolic blood pressure have been reported (Schum et al., 2003; Spicer and Chamberlain, 1996), but contradictory findings exist (Holroyd and Gorkin, 1983; Igna et al., 2009; Shapiro et al., 1997). “Anger-in” is also positively correlated with systolic blood pressure reactivity during stressful tasks (Burns, 1995; Holroyd and Gorkin, 1983; Mills and Dimsdale, 1993; Vogele and Steptoe, 1992), while mixed results exist for “anger-out”. Although consistently associated with higher systolic blood pressure at rest, both positive (Burns, 1995; Faber and Burns, 1996; Vogele and Steptoe, 1992) and negative (Haeri et al., 1996; International Journal of Psychophysiology 79 (2011) 364–370 Abbreviations: ECG, electrocardiogram; EMG, electromyogram; BMI, body mass index; SU, standardized units; mmHg, millimeter mercury; bpm, beats per minute; IAPS, International Affective Picture System; STAXI, State-Trait-Anger-Expression- Inventory; SAM, Self-Assessment Manikin questionnaire. ⁎ Corresponding author. University of Trier, Department of Psychobiology, Johanniterufer 15, 54290 Trier, Germany. Tel.: +49 6512013661; fax: + 49 6512013737. E-mail address: richters@uni-trier.de (S. Richter). 0167-8760/$ – see front matter © 2010 Elsevier B.V. All rights reserved. doi:10.1016/j.ijpsycho.2010.12.004 Contents lists available at ScienceDirect International Journal of Psychophysiology journal homepage: www.elsevier.com/locate/ijpsycho