How you express anger could impact your heart health, study finds

A new study suggests that how we handle anger could be a hidden factor in cardiovascular health. The findings, published in Physiology & Behavior, indicate that people with a quick temper, especially those who hold it in, may experience unusual cardiovascular responses to stress—responses that could affect their risk of developing heart disease.

Previous research has shown that anger is linked to a higher risk of heart disease, stroke, and other cardiovascular problems, and some researchers believe that how people respond to anger could play a role in these health risks. By examining how anger affects cardiovascular responses, scientists hoped to uncover new insights into why anger might lead to these health problems.

“Anger personality types have been consistently associated with adverse cardiovascular health outcomes, with atypical stress responses acting as a key pathway leading to disease. We were particularly interested in identifying whether the way individuals express their anger was also an important factor in understanding this relationship,” said study author Adam O’Riordan, an assistant professor of psychology at The University of Texas at San Antonio.

To test their hypotheses, the researchers analyzed data from 669 participants from the Midlife Development in the United States (MIDUS) dataset, who underwent a controlled stress test while their blood pressure and heart rate were closely monitored. They examined two specific facets of anger: anger temperament (the tendency to feel unprovoked, spontaneous anger) and anger reaction (anger triggered by specific situations, like unfair treatment or criticism). They also measured how each participant typically expressed their anger, categorized as “anger-in” (suppressing anger), “anger-out” (directing anger outward), or “anger control” (managing and regulating anger).

To simulate psychological stress, participants completed two tasks known to induce stress responses: a mental arithmetic task and the Stroop task. The arithmetic task required participants to solve math problems under time pressure, while the Stroop task challenged participants to identify the color of a word that named a different color (for example, the word “blue” written in red ink). Both tasks were administered via computer, which recorded participants’ responses and adjusted the difficulty based on performance to maintain a steady level of stress.

Blood pressure (both systolic and diastolic) and heart rate were monitored continuously throughout these tasks using a Finometer device, which measured beat-to-beat cardiovascular responses. Additionally, before and after the stress tasks, participants rated their stress levels on a scale of 1 to 10, providing insight into their perceived stress in response to each task.

The findings showed distinct patterns in how anger-related traits and expression styles influenced cardiovascular reactions. People who frequently felt anger across many situations—classified as having high anger temperament—tended to show a “blunted” response, meaning their heart rate and blood pressure increased less than expected under stress. However, these individuals reported feeling more stressed, despite their bodies showing a lower cardiovascular response.

Interestingly, the effect of anger temperament on cardiovascular response depended on how the individual expressed their anger. Those who frequently suppressed their anger (anger-in) showed even lower increases in blood pressure when experiencing anger temperament, suggesting that holding in unprovoked anger could further dampen the cardiovascular response.

Participants who tended to feel anger as a reaction to specific triggers, like frustration or unfairness, had different cardiovascular responses depending on how they expressed their anger. Those who typically expressed anger outwardly or had limited control over their anger exhibited lower cardiovascular reactivity when they felt triggered anger. In contrast, those who managed their anger (high anger control) showed stronger cardiovascular responses, with higher blood pressure and heart rate increases during the stress tasks.

This controlled response suggests that having a healthy way to manage anger may lead to a more “normal” cardiovascular reaction, which some researchers believe could be beneficial for long-term heart health. Blunted cardiovascular responses, on the other hand, have been linked to potential health issues, including lack of motivation, psychological difficulties, and lifestyle factors that may contribute to cardiovascular disease.

The study’s findings highlight that how people experience and express anger can have meaningful effects on their physiological reactions to stress. While anger temperament (quick, unprovoked anger) was associated with lower cardiovascular responses in general, this effect was intensified in those who suppressed their anger.

“The key findings from this study suggest that while individuals vary in terms of how they experience anger, it is extremely important to consider how these individuals express their anger. In particular, the adverse effect of high anger temperament on stress physiology appears to be heightened amongst individuals who suppress this anger,” said O’Riordan.

While the study sheds light on how anger can affect the heart, it does have some limitations. The stress tasks used in the experiment, like math problems and color-word matching, may not fully capture the real-life scenarios that typically provoke anger, such as arguments or unfair treatment.

Future research could explore how people react in more realistic anger-inducing situations. Additionally, it could examine how repeated exposure to stress affects cardiovascular reactions, as the current study only focused on single stress events. This type of research could help reveal patterns in how individuals’ bodies respond to recurring stressful situations and show whether different anger management techniques can promote a healthier heart response.

The study, “Examining the moderating effects of anger expression style on the association between facets of trait anger and cardiovascular responses to acute psychological stress,” was authored by Adam O’Riordan and Aisling M. Costello.