Literature supporting a relationship between emotions and regulation of blood pressure dates back to the early 1900s. Theoretical explanations of the pathophysiology of the correlation have centered on several possible trajectories, the most likely being cardiovascular reactivity to stress. Prospective studies have demonstrated that chronic stress and enduring traits such as defensiveness and anxiety, impacts the development of hypertension. An analysis of 195 genetic males seeking contrary hormones for treatment of gender dysphoria revealed a significantly increased prevalence of hypertension in this cohort. The authors attribute this increased prevalence to the known effects of emotional disclosure on health and conclude that the inhibition of emotional expressiveness is significant in the etiology and maintenance of essential hypertension in this population. As hypertension is associated with morbidity and mortality, the implications for the family medicine physician treating gender nonconforming individuals and other patients in the context of a general medical practice will be discussed. 1. Introduction Early psychosomatic theorists proposed that anger, hostility, and depression gave rise to hypertension [1]. Recent well-designed prospective studies document that chronic stress, as well as personality characteristics and emotional states, are associated with essential hypertension [2]. One such study evaluated 4,861 participants, aged 45–70, who lived near a major airport for at least five years. Exposure to airport noise was associated with a 14% rise in risk of hypertension [3]. Hypertension is one of the most common worldwide diseases afflicting humans. Owing to the associated morbidity and mortality, and the cost to society, hypertension is an important public health challenge. Concerted effort on the part of the health care professionals has led to decreased mortality and morbidity rates from the multiple organ damage arising from years of untreated hypertension. Prevalence rates of hypertension vary enormously, particularly between rural and urban populations, lending credence to the importance of environmental factors in the etiology of the disease process. Populations living in rural areas typically have lower prevalence rates of hypertension than those living in urban areas. In the USA, the prevalence rate of hypertension is approximately 21–24% in individuals between 20–80 years. This rate has remained unchanged since 1999. The lowest prevalence rate worldwide is among men living in rural India, the highest prevalence rate is found in
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