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Journal of Behavioral Medicine [jobm] pp949-jobm-470706 August 28, 2003 21:7 Style file version Feb 25, 2000
INTRODUCTION
Researchers have long suspected that trait anger and anger expression
are personality factors associated with the development of hypertension. A
recent meta-analysis by Suls et al. (1995) found that anger experience was
positively associated with higher levels of resting systolic blood pressure.
Elevations of blood pressure observed in clinical and research laboratory
1Department of Psychology and Center for Health and Behavior, Syracuse University, Syracuse,
New York.
2To whom correspondence should be addressed at Department of Psychology, 430 Huntington
Hall, Syracuse, New York 13244.
395
0160-7715/03/1000-0395/0 °
C 2003 Plenum Publishing Corporation
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Journal of Behavioral Medicine [jobm] pp949-jobm-470706 August 28, 2003 21:7 Style file version Feb 25, 2000
Because the relationship between trait anger and high blood pressure
is hypothesized to depend on CVR, the development of ambulatory blood
pressure monitors extended the capability of researchers in this field by
allowing them to obtain frequent measurements of blood pressure nonin-
vasively, without the confounding influence of a laboratory setting. These
monitors also increased the ability of researchers to investigate the indi-
rect relationship (e.g., transactional model) between trait anger and blood
pressure by allowing researchers to look at individuals’ blood pressure re-
sponses within their natural social environment, eliminating the obstacles of
constructing social stressors within the laboratory. Ambulatory blood pres-
sure monitoring, therefore, provides researchers with more externally valid
evidence regarding an individual’s overall blood pressure reactivity than that
obtained in the laboratory (Pickering et al., 1994).
A common theme among the ambulatory blood pressure research in-
vestigating trait anger is the ambiguity surrounding trait anger’s definition.
Anger has been described as the experience of unpleasant emotion that
ranges in intensity from annoyance to rage. Trait anger refers to the more
stable individual difference to experience anger frequently and intensely
(Miller et al., 1996). The approaches used to measure trait anger vary in
their assessment of the cognitive, affective, and behavioral components of
anger. Another problem adding to the ambiguity is the construct definitions
of trait anger and hostility are often overlapped or used interchangeably
(Spielberger et al., 1983, 1988). Hostility is defined as a stable cognitive
attitude characterized by cynicism and a general lack of trust in others
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Journal of Behavioral Medicine [jobm] pp949-jobm-470706 August 28, 2003 21:7 Style file version Feb 25, 2000
METHODS
Sample of Studies
The following information was extracted from each study for primary
analyses and descriptive purposes: (a) year and form of publication;
(b) sample size; (c) gender composition of sample; (d) mean age; (e) race
of participants; (f) hypertension status of participants; (g) occupation of
participant (student, blue collar, white collar, mixed, or unknown); (h) num-
ber of hours ambulatory blood pressure was assessed; (i) type of schedule
for ambulatory blood pressure monitors (random vs. constant); (j) type of
blood pressure assessed (systolic blood pressure, diastolic blood pressure,
both); (k) period blood pressure was taken (sleep, awake); (l) location blood
pressure was taken (work, home); (m) type of trait anger measures used;
(n) whether trait anger was continuous or categorical; (o) if categorical, how
the participants were split into groups (median split, quartiles) and number
of participants in each group; and (p) type of statistical test used. Two raters
separately coded each study to decrease error. Three discrepancies were
found in the coding. Those errors were discussed and resolved.
anger expression and anger experience. The eight measures and their sub-
scales included in the meta-analysis were classified into these dimensions by
examining the content of the items on the scale. This procedure of dimension
classification is widely accepted and has been used in other published meta-
analyses (Miller et al., 1996; Suls et al., 1995; Suls and Wan, 1993). Those
scales that contained items that assessed primarily the internal experience
of anger (e.g., irritability, cynicism, frustration, suspicion, and annoyance)
were categorized within the anger experience dimension. Because of the
small number of studies included in this meta-analysis, any measures that
contained a mixture of items were categorized based on what the majority
of items on the scale assessed. The self-report scales assigned to the anger
experience dimension included the Behavioral Anger Response Scale (i.e.,
avoidance subscale; Hogan, 2001), Buss–Durkee Hostility Inventory (i.e.,
overall scale; Buss, 1961), Cook–Medley Hostility scale (i.e., overall scale;
Cook and Medley, 1954), Multidimensional Anger Inventory (i.e., overall
scale, range of anger subscale, hostility subscale, and anger arousal subscale;
Siegal, 1986), Symptom Checklist-90R (i.e., hostility subscale; Derogatis,
1977), Spielberger State Trait Anger Inventory (i.e., trait anger subscale;
Spielberger et al., 1983), and Spielberger’s Anger Expression Inventory (i.e.,
anger-in subscale; Spielberger et al., 1988). In addition, the Structured Inter-
view for Type A behavior (i.e., content hostility and potential for hostility
subscales) is a behavioral measure of hostility included in the experience of
anger dimension (Dembroski and Costa, 1987).
Scales with items that assessed primarily the behavioral component
of anger (i.e., insults, shouting, sarcasm, physically attacking, and covert as-
saulting behaviors) were categorized in the anger expression dimension. The
self-report scales assigned to the expression of anger dimension included the
Behavioral Anger Response Scale (i.e., aggression subscale; Hogan, 2001)
and the Spielberger Anger Expression Inventory (i.e., anger-out subscale;
Spielberger et al., 1988).
The effect size, r , was calculated between each anger dimension and
ambulatory blood pressure using procedures outlined by Hedges and Olkin
(1985). Every effect size was calculated separately for systolic and diastolic
blood pressure. Researchers have stated that it is essential for systolic and
diastolic blood pressure to be investigated independently because they may
react differently (e.g., systolic blood pressure may increase, whereas diastolic
blood pressure may not change), and therefore, not always represent the
same underlying physiological state (Jorgensen et al., 1996). Systolic and
diastolic blood pressure also may have different capacities to predict future
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RESULTS
Primary Analysis
Tables II and III list the individual effect sizes for each study included
when investigating the effect of the experience and expression of anger on
systolic and diastolic blood pressure, respectively.
Experience of Anger
Expression of Anger
Table I. The Variables Coded for Each Study Included Within the Meta-Analysis
Authors Year N females American Caucasian range participants participants vs. continuous (h) (min) scheduling
404
Hayashi 1992 161 71 48 113 25–54 0 Adults Continuous 13 20 Random
community
Hogan 2001 158 68 158 Adults Continuous 24 20 Nonrandom
Pasic et al. 1994 42 19 7 28 35–65 42 Patients Continuous 24 20 Nonrandom
community
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clerical
Rutledge et al. 2000 329 172 0 230 0 Students Continuous 10 20 Nonrandom
community
Shapiro et al. 1996 144 71 58 86 0 Students Continuous 24 20 Random
Shapiro et al. 1993 54 15 0 44 19–44 0 Paramedic Categorical 92 15 Random
Table II. Averaged Correlations for Each Study Included When Analyzing Trait Anger Effects on Systolic Blood Pressure
Anger dimension and authors Outcome measures Multiple indicatorsa Nb Gender Race r
Experience of Anger
Benotsch et al. (1997) Cook–Medley Hostility Scale 24 M 0.348
24 F 0.208
Brownley (1996) Multidimensional Anger 35 F C 0.216
Inventory (Hostility subscale)
27 F A −0.077
37 M C 0.219
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30 M A −0.501
Durel et al. (1989) Spielberger Trait Anger Inventory Measures 131 M/F 0.125
(anger-in subscale), Cook–Medley
Hostility Inventory
Ewart and Kolodner (1994) Modified Multidimensional Measures 70 F A 0.051
Anger Inventory—Range of
Anger and Anger Arousal subscales
44 F C −0.041
Trait Anger and Ambulatory Blood Pressure
67 M A −0.005
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47 M C 0.178
Friedman et al. (2001) Spielberger Anger Expression Measures 248.3 M 0.003
Scale (anger-in subscale),
Spielberger Trait Anger
Inventory, Symptom Checklist
90-R Hostility Subscale
Goldstein and Shapiro (2000) Cook–Medley Hostility Scale Location 203 F 0.035
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68 F 0.114
Pasic et al. (1994) Buss–Durkee Hostility Inventory 35 M/F 0.265
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Anger dimension and authors Outcome measures Multiple indicatorsa Nb Gender Race r
406
Expression of Anger
Friedman et al. (2001) Spielberger Anger Expression 249 M −0.060
Scale (anger-out subscale)
Goldstein and Shapiro (2000) Spielberger Anger Expression Location 201 F −0.017
Scale (anger-out subscale)
Hayashi (1992)c Spielberger Anger Expression 60 M C −0.040
Scale (anger-out subscale)
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23 M A 0.130
44 F C −0.090
15 F A
21:7
−0.220
Hogan (2001) Behavioral Anger Response 90 M −0.120
Scale (Aggression subscale)
68 F −0.120
Rutledge et al. (2000) Spielberger Anger Expression 329 M/F −0.050
Scale (anger-out subscale)
Shapiro et al. (1993) Spielberger Anger Expression Location 53 M/F 0.369
Scale (anger-out subscale)
Table III. Averaged Correlations for Each Study Included When Analyzing Trait Anger Effects on Diastolic Blood Pressure
Anger dimension and authors Outcome measure Multiple indicatorsa Nb Gender Race r
Experience of Anger
Benotsch et al. (1997) Cook–Medley Hostility Scale 24 M 0.035
24 F 0.042
Durel et al. (1989) Spielberger Trait Anger Inventory Measures 131 M/F 0.120
(anger-in subscale)/Modified
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Cook–Medley
Ewart and Kolodner (1994) Modified Multidimensional Measures 70 F A 0.010
Anger Inventory—Range of
Anger and Anger Arousal
subscales
44 F C 0.115
67 M A 0.144
47 M C 0.282
Trait Anger and Ambulatory Blood Pressure
23 M A −0.087
44 F C −0.075
15 F A 0.105
Hogan (2001) Behavioral Anger Response Measures 90 M 0.015
Questionnaire (Avoidance
subscale), Cook–Medley
Hostility Questionnaire
68 F 0.106
Pasic et al. (1994) Buss–Durkee Hostility Inventory 35 M/F 0.227
407
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Anger dimension and authors Outcome measure Multiple indicatorsa Nb Gender Race r
31.5 F A 0.223
Raikkonen et al. (1999) 13-item Cook–Medley Hostility Measures 100 M/F 0.027
Scale/Structured Interview for
Type A Behavior (Content and
Potential for Hostility subscales)
Rutledge et al. (2000) Spielberger Anger Expression Measures 329 M/F −0.030
Scale (anger-in subscale)/
Cook–Medley Hostility Scale
Expression of Anger
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44 F C −0.170
15 F A −0.130
21:7
b The average value of N was used when sample sizes for multiple effect sizes differed by less than five participants.
c Only used home values of blood pressure.
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Journal of Behavioral Medicine [jobm] pp949-jobm-470706 August 28, 2003 21:7 Style file version Feb 25, 2000
DISCUSSION
investigating the relationship between anger (Suls et al., 1995), negative af-
fect (Jorgensen et al., 1996), and laboratory/clinic blood pressure. In addition,
these effect sizes are only slightly smaller than those reported on traditional
risk factors (i.e., smoking, elevated serum cholesterol) for coronary artery
disease (Review Panel on Coronary-Prone Behavior and Coronary Heart
Disease, 1978). Even though this effect appears modest, even small effect
sizes have been considered important for public health. For instance, the
effect of aspirin on reducing risk of heart attack has long been supported as
a worthwhile treatment, although the actual effect size is 0.034 (Rosenthal,
1990). Therefore, even small effect sizes may indicate that personality con-
tributes to the development of diseases of the cardiovascular system in some
cases (Booth-Kewley and Friedman, 1987).
Methodological Limitations
It should be noted that the small size of the effect found in this meta-
analysis might be partially due to several methodological limitations of the
included studies and the meta-analysis itself.
Personality Measures
Participant Demographics
Biopsychosocial Synergism
Summary
REFERENCES
References marked with an asterisk indicate studies included within the meta-analysis.
Alexander, F. (1939). Emotional factors in essential hypertension. Psychosom. Med. 1: 175–179.
Applegate, W. B. (1989). Hypertension in elderly patients. Ann. Intern. Med. 110: 901–915.
*Benotsch, E. G., Christensen, A. J., and McKelvey, L. (1997). Hostility, social support, and
ambulatory cardiovascular activity. J. Behav. Med. 20: 163–176.
Booth-Kewley, S., and Friedman, H. S. (1987). Psychological predictors of heart disease: A
quantitative review. Psychol. Bull. 101: 343–362.
*Brownley, K. (1996). Acute Aerobic Exercise and Social Support Buffer, Cardiovascular Re-
sponses to Stress: An Examination of Race Differences in Underlying Physiological and Psy-
chosocial Differences, Unpublished Doctoral Dissertation, University of North Carolina,
Chapel Hill.
Buss, A. H. (1961). The Psychology of Aggression, Holt, Rinehart, and Winston, New York.
Carels, R. A., Sherwood, A., and Blumenthal, J. A. (1998). Psychosocial influences on blood
pressure during daily life. Int. J. Psychophysiol. 28: 117–120.
Contrada, R. J., and Jussim, L. (1992). What does the Cook–Medley Hostility Scale measure?
In search of an adequate measurement model. J. Appl. Soc. Psychol. 22: 615–627.
Cook, W. W., and Medley, D. M. (1954). Proposed hostility and pharisaic-virtue scales for the
MMPI. J. Appl. Psychol. 238: 414–418.
De Guademaris, R., Mallion, J. M., Battistella, P., Battistella, B., Siche, J. P., Blatier, J. F., and
Francois, M. (1987). Ambulatory blood pressure and variability by age and sex in 200
normotensive subjects: Reference population values. J. Hypertens. 5: S429–S430.
Dembroski, T. M., and Costa, P. T. (1987). Coronary prone behavior: Components of the Type
A pattern and hostility. J. Pers. 55: 211–235.
Derogatis, L. R. (1977). SCL-90 Revised Version Manual, John Hopkins University School of
Medicine, Baltimore.
*Durel, L. A., Carver, C. S., Spitzer, S. B., Llabre, M. M., Weintraub, J. K., Saab, P. G., and
Schneiderman, N. (1989). Associations of blood pressure with self-report measures of
anger and hostility among black and white men and women. Health Psychol. 8: 557–575.
Ewart, C. K. (1991). Familial transmission of essential hypertension: Genes, environments, and
chronic anger. Ann. Behav. Med. 13: 40–47.
*Ewart, C. K., and Kolodner, K. B. (1994). Negative affect, gender, and expressive style predict
elevated ambulatory blood pressure in adolescents. J. Pers. Soc. Psychol. 66: 596–605.
Fredrikson, M. (1991). Psychophysiological theories on sympathetic nervous system reactivity
in the development of essential hypertension. Scand. J. Psychol. 32: 254–274.
Fredrikson, M., and Matthews, K. A. (1990). Cardiovascular responses to behavioral stress and
hypertension: A meta-analytic review. Ann. Behav. Med. 12: 30–39.
P1: IZO
Journal of Behavioral Medicine [jobm] pp949-jobm-470706 August 28, 2003 21:7 Style file version Feb 25, 2000
Fredrikson, M., Robson, A., and Ljungdell, T. (1991). Ambulatory and laboratory blood pres-
sure in individuals with negative and positive family history of hypertension. Health Psy-
chol. 10: 371–377.
*Friedman, R., Schwartz, J. E., Schnall, P. L., Landsbergis, P. A., Pieper, C., Gerin, W., and
Pickering, T. G. (2001). Psychological variables in hypertension: Relationship to casual or
ambulatory blood pressure in men. Psychosom. Med. 63: 19–31.
Gellman, M., Spitzer, S., Ironson, G., Llabre, M., Saab, P., Pasin, R. D., Weidler, D. J., and
Schneiderman, N. (1990). Posture, place, and mood effects on ambulatory blood pressure.
Psychophysiology 27: 544–551.
Gerin, W., Pickering, T. G., Glynn, L., Christenfeld, N., Schwartz, A., Carroll, D., and Davidson,
K. (2000). An historical context for behavioral models of hypertension. J. Psychosom. Res.
48: 369–377.
*Goldstein, I. B., and Shapiro, D. (2000). Ambulatory blood pressure in women: Family history
of hypertension and personality. Psychol. Health Med. 5: 227–240.
*Guyll, M., and Contrada, R. J. (1998). Trait hostility and ambulatory cardiovascular activity:
Responses to social interaction. Health Psychol. 17: 30–39.
*Hayashi, P. J. (1992). Anger-In, Anger-Out, and Hostility: Associations With Clinic and Ambu-
latory Blood Pressure in a Biracial Sample of Normotensive and Hypertensive Males and
Females, Unpublished Doctoral Dissertation, University of Miami, Miami.
Hedges, L. V., and Olkin, I. (1985). Statistical Methods for Meta-Analysis, Academic Press, New
York.
Helmers, K. F., Baker, B., O’Kelly, B., and Tobe, S. (2000). Anger expression, gender, and
ambulatory blood pressure in mild, unmedicated adults with hypertension. J. Behav. Med.
22: 60–64.
*Hogan, B. (2001). Anger Response Styles and Cardiovascular Health, Unpublished Doctoral
Dissertation, University of British Columbia, British Columbia.
Jamner, L. D., Shapiro, D., Goldstein, I. B., and Hug, R. (1991). Ambulatory blood pressure
and heart rate in paramedics: Effects of cynical hostility and defensiveness. Psychosom.
Med. 53: 393–406.
Jorde, L. P., and Williams, R. R. (1996). Innovative blood pressure measurements yield infor-
mation not reflected by sitting measurements. Hypertension 8: 252–257.
Jorgensen, R. S., Johnson, B. T., Kolodziej, M. E., and Schreer, G. E. (1996). Elevated blood
pressure and personality: A meta-analytic review. Psychol. Bull. 120: 293–320.
Kornegay, C. J. (1998). Effect of Social Support on the Relationship Between Hostility and Seated
Blood Pressure and Anger Expression and Ambulatory Blood Pressure in a Bi-Ethnic
Community Group, Unpublished Doctoral Dissertation, University of North Carolina at
Chapel Hill, Chapel Hill.
Kubzansky, L. D., and Kawachi, I. (2000). Going to the heart of the matter: Do negative emotions
cause coronary heart disease? J. Psychosom. Res. 48: 323–337.
Lundberg, U., Hedman, M., Melin, B., and Frankenhaeuser, M. (1989). Type A behavior in
healthy males and females as related to physiological reactivity and blood lipids. Psycho-
som. Med. 51: 113–122.
Manuck, S. B. (1994). Cardiovascular reactivity in cardiovascular disease: “Once more unto the
breach.” Int. J. Behav. Med. 1: 4–31.
Miller, T. Q., Smith, T. W., Turner, C. W., Guijarro, M. L., and Hallet, A. J. (1996). A meta-
analytic review of research on hostility and physical health. Psychol. Bull. 119: 322–348.
Musante, L., MacDougall, J. M., Dembroski, T. M., and Costa, P. T. (1989). Potential hostility
and dimensions of anger. Health Psychol. 8: 343–354.
Myers, H. F., and McClure, F. H. (1993). Psychosocial factors in hypertension in Blacks: The case
for an interactional perspective. In Fray, J. C. S., and Douglas, J. G. (Eds.), Pathophysiology
of Hypertension in Blacks, Oxford University Press, New York, pp. 69–89.
*Pasic, J., Shaprio, D., Jamner, L. D., and Hui, K. K. (1994). Hostility and the response to diuretic
in mild-to-moderate hypertension. Am. J. Hypertens. 7: 503–508.
Pickering, T. G. (1982). Hypertension, definitions, natural histories and consequences. Am. J.
Med. 52: 570–583.
P1: IZO
Journal of Behavioral Medicine [jobm] pp949-jobm-470706 August 28, 2003 21:7 Style file version Feb 25, 2000
Pickering, T., Alpert, B. S., DeSwiet, M., Harshfield, G., O’Brien, E., and Shennan, A. H. (1994).
Ambulatory Blood Pressure, SpaceLabs Medical, Redmond, WA.
Pickering, T. G., and Friedman, R. (1991). The white coat effect: A neglected role for behavioral
factors in hypertension. In McCabe, P. M., Schneiderman, N., Field, T. M., and Skyler, J. S.
(Eds.), Stress, Coping, and Disease, Erlbaum, Hillsdale, NY, pp. 35–49.
Pickering, T. G., Phil, D., and Gerin, W. (1990). Cardiovascular reactivity in the laboratory and
the role of behavioral factors in hypertension: A critical review. Ann. Behav. Med. 12: 3–16.
*Polk, D. E., Kamarck, T. W., and Shiffman, S. (2002). Hostility explains some of the discrepancy
between daytime ambulatory and clinic blood pressures. Health Psychol. 21: 202–206.
Porter, L. S., Stone, A. A., and Schwartz, J. E. (1999). Anger expression and ambulatory blood
pressure: A comparison of state and trait measures. Psychosom. Med. 61: 454–463.
Raikkonen, K., Matthews, K. A., Flory, J. D., and Owens, J. F. (1999). Effects of hostility on
ambulatory blood pressure and mood during daily living in healthy adults. Health Psychol.
18: 44–53.
Review Panel on Coronary-Prone Behavior and Coronary Heart Disease (1978). Coronary-
prone behavior and coronary heart disease: A critical review. Circulation 65: 1199–1215.
Rosenthal, R. (1990). How are we doing in soft psychology? Am. Psychol. 45: 775–777.
*Rutledge, T., Linden, W., and Davies, R. F. (2000). Psychological response styles and cardio-
vascular health: Confound or independent risk factor? Health Psychol. 19: 441–451.
Saab, P. G. (1989). Cardiovascular and neuroendocrine responses to challenges in males and
females. In Schneiderman, N., Weiss, S. M., and Kaufmann, P. G. (Eds.), Handbook of
Research Methods in Cardiovascular Behavior Medicine, Plenum, New York, pp. 453–
481.
*Shapiro, D., Goldstein, I. B., and Jamner, L. D. (1996). Effects of cynical hostility, anger out,
anxiety, and defensiveness on ambulatory blood pressure in black and white college stu-
dents. Psychosom. Med. 58: 354–364.
*Shapiro, D., Jamner, L., and Goldstein, I. B. (1993). Ambulatory stress psychophysiology: The
study of “compensatory and defensive counterforces” and conflict in a natural setting.
Psychosom. Med. 55: 309–323.
Shaw, W. S. (1998). The Effect of Inhibition of Hostility on Blood Pressure in Stressed Alzheimer
Caregivers, Unpublished Doctoral Dissertation, University of California, San Diego.
Siegel, J. M. (1986). The multidimensional anger inventory. J. Pers. Soc. Psychol. 51: 191–200.
Smith, T. W. (1992). Hostility and health: Current status of psychosomatic hypothesis. Health
Psychol. 11: 139–150.
Smith, T. W., and Christensen, A. J. (1992). Cardiovascular reactivity and interpersonal relations:
Psychosomatic processes in social context. J. Soc. Clin. Psychol. 11: 279–301.
Smith, T. W., and Frohm, K. D. (1985). What’s so unhealthy about hostility? Construct validity
and psychosocial correlates of the Cook Medley Ho scale. Health Psychol. 4: 503–530.
Spielberger, C. D., Jacobs, G., Russell, S., and Crane, R. (1983). Assessment of anger: The state-
trait anger scale. In Butcher, N., and Spielberger, C. D. (Eds.), Advances in Personality
Assessment, Vol. 2, Erlbaum, Hillsdale, NJ, pp. 169–189.
Spielberger, C. D., Krasner, S. S., and Solomon, E. P. (1988). The experience, expression, and
control of anger. In Janisse, M. P. (Ed.), Health Psychology: Individual Differences and
Stress, Springer-Verlag, New York, pp. 89–108.
Stroup-Benham, C. A. (1994). Ambulatory Blood Pressure and Heart Rate Characteristics
Among Nurses: Relationships With Anthropometric and Psychosocial Attributes, Unpub-
lished Doctoral Dissertation, University of Texas Medical Branch, Galveston.
Suls, J., and Wan, C. K. (1993). The relationship between trait hostility and cardiovascular
reactivity: A quantitative review and analysis. Psychophysiology 30: 615–626.
Suls, J., Wan, C. K., and Costa, P. T. (1995). Relationship of trait anger to resting blood pressure:
A meta-analysis. Health Psychol. 14: 444–456.
Williams, C. L. (1996). Hostility, Anger-In, and Social Support: Ambulatory Blood Pressure
and Heart Rate in Female 911 Police Dispatchers, Unpublished Doctoral Dissertation,
University of California, Los Angeles.