Psychosomatic pathways to essential hypertension: the combined effect of anger and family history of cardiovascular disorders on cardiovascular reactivity

Previous results from our laboratory suggest a combined effect of anger-suppression and family history of cardiovascular disorders in determining cardiovascular responses to mental stress. The present study was designed to determine the effect sizes in cardiovascular reactivity associated with biological risk, psychological risk and the combination of these risk factors using meta-analytical techniques. Results from three independent studies with almost identical experimental procedures provided the basis for the calculation of d, the difference between the means of two groups, divided by the pooled within-group standard deviation. Effect sizes were calculated for the comparison of high versus low biological hypertension risk, high versus low anger suppression, and high versus low combined risk. The results show the largest effect sizes for the comparison of high versus low combined risk. The effect sizes associated with the combination of risk factors were larger than the sum of the effect sizes associated with either factor alone. We conclude that the combination of biological and psychological risk factors in determining cardiovascular reactivity to mental stress is more than the sum of its parts. These findings are discussed in terms of a better understanding of the over-additive effects of multiple cardiovascular risk factors on cardiovascular morbidity and mortality.