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A study of anger could help determine if hypertension can be handled by teaching hotheads and people who sit and simmer how to handle the emotion more appropriately, a researcher says.

"There must be at least a hundred studies out there showing that blood pressure and anger are related, but no one has tried to change the way a person expresses their anger in order to lower their blood pressures," said West Virginia University clinical psychologist Kevin Larkin."We're not certain if anger causes high blood pressure or if high blood pressure causes difficulties with expressing anger.

"We're hoping if we teach people to express their anger appropriately, their blood pressure will come down."

Larkin's study, funded by the American Heart Association, will test the effect of a 12-week training program on people with borderline or moderate high blood pressure. Half the subjects will receive assertiveness training and learn relaxation techniques. A control group will receive no training. Both groups' blood pressures will be tested before and after the training.

The training includes role playing and "stress inoculations," he said. "We teach people how to handle their stress and then expose them to little bits of stress and anger situations. We then increase the potential anger so they get used to handling bigger and more intense anger problems."

The trained group should be able to express anger without hurting others, react in a more subdued manner to provocation and have lower blood pressures at rest. "We're confident that we'll be able to show the first two. We're keeping our fingers crossed on being able to lower baseline blood pressures."

The training helps alleviate two types of responses shown to be harmful: "anger-in," in which the response is suppressed, and "anger-out," in which it is vented aggressively. "The anger-in person feels bad because they didn't express their anger openly," Larkin said. "The anger-out person feels pretty guilty because they attacked or offended somebody else.

"In both cases, people feel pretty lousy about themselves."

A third type, "reflective coping," in which anger is handled rationally after tempers have cooled, has little effect on blood pressure, he said.