Secrecy and the pathogenesis of hypertension.

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.