• Behavioural stress;
  • psychosocial factors;
  • blood pressure;
  • hypertension;
  • ethnicity


The objective of the study was to test the hypothesis that behavioural stress is associated with hypertension in developing countries. It forms part (students only) of a large study on the population of South Africa. The cross-sectional study involved 2902 black, white and Indian African students, stratified by year of study, gender and ethnicity. Harburg's anger-coping scale and James' active coping scale (JHACS) were used. For assessment of socioeconomic status a coefficient of family instability (CFIS) was used. Traditional risk factors of hypertension (family history, alcohol consumption, smoking, urbanization) and biological parameters (systolic and diastolic blood pressure, pulse rate, body mass and skinfold, glucose tolerance) were taken. Hypertension was defined as blood pressure higher than 160/95 mmHg. A significant association between suppressed anger, high CFIS and blood pressure level in all three ethnic groups was found, most strongly expressed in male black students. The risk for hypertension was increased if this construct was combined with high JHACS score and/or poor performance at the university. After controlling for biological variables, this psychological construct still had strong association with blood pressure level/hypertension incidence in black males only. The person-environment interaction (gender, ethnicity, years of study, urbanization) might thus represent a behavioural stress that promotes development of hypertension in African developing countries.