Table of Contents
International Journal of Family Medicine
Volume 2012, Article ID 492718, 3 pages
Research Article

Secrecy and the Pathogenesis of Hypertension

1New Health Foundation Worldwide, 1214 Lake Street, Evanston, IL 60201, USA
2Clinical Instructor Feinberg School of Medicine, Northwestern University, Department of Family Medicine, 420 East Superior Street, Chicago, IL 60611, USA
3Department of Child and Adolescent Psychiatry, Erasmus MC-Sophia/Kamer SP-2869, Postbus 2060, 3000 CB, Rotterdam, The Netherlands

Received 23 November 2011; Revised 28 March 2012; Accepted 14 June 2012

Academic Editor: Jan De Lepeleire

Copyright © 2012 Randi Ettner et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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.