Nov 20, 2002 (United Press International via COMTEX) -- An unusually long and large heart study presents the first direct evidence that restlessly rushing through life can put a person on the fast track to hypertension, also known as high blood pressure, scientists said Wednesday.
The unique 15-year survey of 3,138 young black and white men and women zeroed in on the cardiovascular effects of the hurry-up component of what psychologists refer to as Type A personality. These individuals share three key traits: extreme competitiveness, impatience and hostility. Studies long have pointed to a potential connection between such intense behavior and an elevated risk of high blood pressure and heart problems, although not conclusively enough to make it a foregone conclusion.
In a departure from the previous focus on hostility as a prime hypertension instigator, the new investigation zoomed in on what professionals call the time urgency and impatience factor, or TUI. This refers to feeling under pressure for time and showing little interest in slowing down.
The researchers examined the relationship between the chronic need for speed and the years-down-the-road development of hypertension in urban adults. The 586 black men, 825 black women, 822 white men and 905 white women who participated began the study at ages ranging from 18 to 30.
"Our findings indicate TUI assessed during young adulthood is associated with increased risk of hypertension years later," said lead author LiJing Yan, research assistant professor of preventive medicine at Northwestern University in Evanston, Ill. "In general, the stronger the feelings of impatience and time pressure, the higher the risk of developing hypertension in the long term."
The findings from this first-of-a-kind study need to be confirmed by further research, Yan told United Press International.
At least one scientist advised against reading too much into the results, however, saying they likely do not portend major harm to the average person.
Others expressed surprise at the wide gap in hypertension risk faced by groups on opposite ends of the time-sensitivity spectrum. The research revealed a more-than-two-fold difference between those with never a moment to spare and those with too much time on their hands.
Conclusions from the pioneering study were presented at the American Heart Association's Scientific Sessions 2002 in Chicago.
The findings are of interest because hypertension -- which affects 10 percent to 30 percent of the world's population -- is a strong risk factor for heart disease, the No. 1 killer in America, responsible for half of all deaths. Worldwide, cardiac disorders claim some 12 million lives each year, the World Health Organization estimates.
Researchers have been exploring a wide array of influences that might alter the course of the disease. Some previous studies suggested individuals engaging in Type A behavior run an increased risk -- as much as two-and-a-half-times higher than their calmer, gentler peers -- of developing high blood pressure and coronary heart disease. Other investigations, however, failed to make such a connection.
The inconclusive results prompted scientists to investigate the possibility that different personality components produce varying health risks. Many turned their attention to hostility as the most likely element to do harm, but thus far they have failed to demonstrate its role unequivocally.
The authors of the new study decided it was time to look closer at another hallmark of Type A personality: the persistent preoccupation with time and pronounced impatience.
"TUI has never been adequately examined as a separate trait, despite suggestions that it may be linked to adverse health outcomes," Yan said.
The team relied on information from the large-scale Coronary Artery Risk Development in Young Adults study to track the volunteers. The participants were asked to rate how well such traits as "eating too quickly," "getting quite upset when having to wait for anything," "usually feeling pressed for time" and "often feeling time pressures at the end of a work day" described them. Based on the responses -- which ranged from "very well" to "not at all" -- the researchers determined the subjects' level of time urgency and impatience.
Those with high blood pressure -- defined as anyone on anti-hypertension medication or with readings of 140 over 90 or higher -- at the start of the study were excluded from the follow-up.
Only 6 percent of the participants gave positive responses in all areas, placing at the top of the TUI scale. Over the course of the study, 17 percent of them developed hypertension, compared to 10 percent for those with the lowest TUI scores. After adjusting for such hypertension factors as age, race, gender, body mass index, physical activity level and alcohol intake, the researchers found the most time-pressed volunteers were more than twice as likely as the least-harried ones to have developed hypertension by the end of the study.
"This is the first definitive demonstration of the time urgency-hypertension association," said Dr. David Calhoun, medical director of the Vascular Biology and Hypertension Program at the University of Alabama, Birmingham.
"What surprises me is the magnitude of the increased risk in patients with the highest level of time urgency," he said in a telephone interview. "Their risk was two and a half times that of subjects in the lowest group. That's very striking."
A statistically significant difference exists only between the two extremes, said Dr. Samuel Mann, a hypertension specialist at New York Presbyterian Hospital-Weill/Cornell Medical School in New York City.
"The group with average time urgency (where most people fall) did not appear to differ markedly from the group with the highest time urgency so I would not rush to uncritically accept the results," he said in a telephone interview.
A more interesting question from Mann's point of view is whether hostility had any effect on hypertension development over the lengthy study period.
"Very few studies have followed people for 15 years to see if they develop hypertension. This is unique," said Mann, author of "Healing Hypertension: A Revolutionary New Approach," a book that combines a medical and psychological view of hypertension. "So whatever they find is of interest."
The authors rightly focused on a long-ignored potential factor in hypertension, said John Todaro, assistant professor of psychiatry and human behavior at the Centers for Behavioral and Preventive Medicine at Brown Medical School in Providence, R.I.
"For a long time we disregarded time urgency and other components of Type A personality because of 1980s studies that showed hostility was what was going to predict hypertension," said Todaro, whose own paper on hostility and heart disease was published this week in the journal Health Psychology.
"This study is useful for breaking down the components that might affect hypertension," he said in a telephone interview. "As a psychologist, I'd like to know if it's really this rushing around that will get you in trouble so I can target it in treatment by trying to help patients slow down and manage time more effectively."
The study is of additional value because, unlike most other cardiovascular surveys -- which tend to ignore women and minorities -- it has a good representation of both, said Dr. Barbara Roberts, director of The Women's Cardiac Center at the Miriam Hospital in Providence, R.I., and clinical associate professor of medicine at Brown University.
"The findings are very interesting," she said in a telephone interview. "The next step would be to do an interventional study in which you identify people who have these emotional characteristics and intervene to see if you can make them less likely to develop hypertension."
In the study, the probability of developing hypertension by year 15 was almost twice as high for black men -- 22 percent -- and women -- 21 percent -- as for white men -- 12 percent. White women had the lowest overall probability, a 5 percent chance of developing high blood pressure by the study's end.
Black men and women in the highest TUI groups were about twice as likely to develop high blood pressure as their counterparts in the lowest TUI groups. White men in the highest group were more than three times as likely to become hypertensive as white men in the lowest group.
"The association between TUI and development of hypertension may be mediated by a variety of lifestyle and other psychosocial factors," said senior study author Kiang Liu, professor of preventive medicine at Northwestern. "The complex processes involved in the link between chronic exposure to TUI and hypertension are not yet well understood."
The study's focus on youth is especially significant, Todaro said.
"The message is directly targeted to the young college student or young worker just entering the work force," he told UPI. "It shows the kind of style that is so pervasive today early in life can have significant health costs later on."
Copyright 2002 by United Press International.