Original Article

Does Behavior Pattern Influence Blood Pressure in the Current Cultural Context of Japan?


Background: Type A behavior pattern has been presented as a risk for coronary heart disease and defined as a psychological-behavioral construct. This study aimed to identify the influence of type A behavior pattern on blood pressure in the current cultural context of Japan.

Methods: This study utilized a cross-sectional design. Self-administered questionnaires were distributed to community residents aged 40-59 yr in western Japan from Aug to Sep 2017. The data included participant’s demographic information (including socioeconomic variables); information related to blood pressure, type A behavior pattern, psychological factors, and health-related behaviors. Logistic regression was used to identify the influence of type A behavior pattern on systolic blood pressure after adjusting for behavioral, psychological, and socioeconomic factors.

Results: The sample included 362 participants with a mean age of 51.5 years (SD = 5.96); 148 (41.2%) men. A logistic regression demonstrated that type A behavior pattern was negatively associated with systolic blood pressure (OR = 0.43, 95% CI [0.22, 0.83]) after adjusting for sex and age. Similar results were observed after adjusting for other covariates.

Conclusion: There may be a negative association between type A behavior pattern and systolic blood pressure among adults living in the current cultural context of Japan.

1. GBD 2017 Causes of Death Collaborators (2018). Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet, 392(10159):1736-1788.
2. Miura K, Nakagawa H, Ohashi Y, et al (2009). Four blood pressure indexes and the risk of stroke and myocardial infarc-tion in Japanese men and women a meta-analysis of 16 cohort studies. Circulation, 119(14):1892-8.
3. Watanabe S, Konta T, Ichikawa K, et al (2019). The association between urinary sodium excretion and blood pressure in a community-based population: the Yama-gata (Takahata) study. Clin Exp Nephrol, 23(3):380–386.
4. Nakamura K, Okamura T, Hayakawa T, et al (2007). The Proportion of Individuals with Alcohol-Induced Hypertension among Total Hypertensives in a General Japanese Population: NIPPON DATA90. Hypertens Res, 30(8):663–8.
5. Rosenman RH, Brand RJ, Jenkins D, et al (1975). Coronary heart disease in Western Collaborative Group Study. Final follow-up experience of 8 1/2 years. JAMA, 233(8):872–7.
6. Williams RB, Lane JD, Kuhn CM, et al (1982). Type A behavior and elevated physiological and neuroendocrine re-sponses to cognitive tasks. Science, 218(4571):483–5.
7. Haynes SG, Feinleib M, Kannel WB (1980). The relationship of psychosocial factors to coronary heart disease ㏌ the fram-ingham study Ⅲ. Eight-year incidence of coronary heart disease. Am J Epidemiol, 111(1):37-58.
8. Cohen JB, Reed D (1985). The type A be-havior pattern and coronary heart disease among Japanese men in Hawaii. J Behav Med, 8(4): 343–52.
9. Shekelle RB, Hulley SB, Neaton JD, et al (1985). The MRFIT behavior pattern study. II. Type A behavior and incidence of coronary heart disease. Am J Epidemiol, 122(4):559–70.
10. Matthews KA (1988). Coronary heart dis-ease and type A behaviors: update on and alternative to the Booth-Kewley and Friedman (1987) quantitative review. Psy-chol Bull, 104(3):373–80.
11. Chida Y, Hamer M (2008). Chronic psycho-social factors and acute physiological re-sponses to laboratory-induced stress in healthy populations: A quantitative review of 30 years of investigations. Psychol Bull, 134(6):829–85.
12. Irvine J, Garner DM, Craig HM, Logan AG (1991). Prevalence of Type A behavior in untreated hypertensive individuals. Hyper-tension, 18(1):72–8.
13. Lachar BL (1993). Coronary-prone behav-ior. Type A behavior revisited. Texas Hear Inst J, 20(3):143–151.
14. Ikeda A, Iso H, Kawachi I, et al (2008). Type A behaviour and risk of coronary heart disease: The JPHC Study. Int J Epidemiol, 37(6):1395–405.
15. Yoshimasu K, Fukuoka Heart Study Group (2001). Relation of type A behavior pat-tern and job-related psychosocial factors to nonfatal myocardial infarction: a case-control study of Japanese male workers and women. Psychosom Med, 63(5):797–804.
16. Maeda S (1985). A Study on behavior pat-tern of patients with coronary heart dis-ease – Application of brief questionnaire. Shinshin-Igaku, 25: 297-306. (In Japanese)
17. Yamazaki Y [Eds.] (2017). Sense of coher-ence, life, and society: National repre-sentative sample survey and analysis. To-kyo: Yushindo koubunsha. (in Japanese)
18. Togari T, Yamazaki Y, Nakayama K, et al (2007). Development of a short version of the sense of coherence scale for popu-lation survey. J Epidemiol Community Health, 61(10):921–922.
19. Zigmond AS, Snaith RP (1983). The hospital anxiety and depression scale. Acta Psychi-atr Scand, 67(6):361–70.
20. Zigmond AS, Snaith RP, Kitamura T [Trans.] (1993). Hospital anxiety and de-pression scale (HADS scale). Archives of Psychiatric Diagnostics and Clinical Evaluation, 4: 371–2. (In Japanese)
21. Matsudaira T, Igarashi H, Kikuchi H, et al (2009). Factor structure of the Hospital Anxiety and Depression Scale in Japanese psychiatric outpatient and student popu-lations. Health Qual Life Outcomes, 7:42.
22. Natsume M, Murata H, Sugimoto K, et al (1988). [The method for stress assess-ment of workers (Part 1) stress score by self-rating method]. Sangyo Igaku, 30(4):266-79. (In Japanese)
23. Wingard DL, Berkman LF, Brand RJ (1982). A multivariate analysis of health-related practices: a nine-year mortality follow-up of the Alameda County Study. Am J Epi-demiol, 116(5):765–75.
24. Evers KE, Prochaska JO, Johnson JL, et al (2006). A randomized clinical trial of a population- and transtheoretical model-based stress-management intervention. Health Psychol, 25(4):521–9.
25. Fujisawa Y, Hamano T, Koyabu A (2007). Influence of social capital of district unit on subjective health. Kosei no Shihyo, 54: 18¬–23. (In Japanese)
26. Glass DC (1977). Stress, behavior patterns, and coronary disease. Am Sci, 65(2):177–87.
27. Ohira T (2010). Psychological distress and cardiovascular disease: the Circulatory Risk in Communities Study (CIRCS). J Epidemiol, 20(3):185–91.
IssueVol 50 No 4 (2021) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijph.v50i4.5994
Coronary prone behavior; Blood pressure; Communities; Culture Middle age

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How to Cite
Fukita S, Kawasaki H, Yamasaki S. Does Behavior Pattern Influence Blood Pressure in the Current Cultural Context of Japan?. Iran J Public Health. 2021;50(4):701-709.