**7. Discussion**

The predictive importance of stress resulting in anger was seen only in the subgroup of participants with high genetic susceptibility to hypertension, defined as having one or more hypertensive parents. It is also important to emphasize that although a family history of hypertension was an important predictor of alterations in BP status on its own, high trait anger greatly potentiated this increased risk of developing elevated BP.

High-stress responsivity itself may have a possible genetic basis. In addition, there is a possible lack of generalizability to older persons because the sample was restricted to 18–65 years. It indicates that any adverse effects of increased life stress or decreased stress buffers would be most evident among those who are both high-stress responders and have a genetic susceptibility to hypertension and heart disease.

This study was conducted at charitable hospitals and in a plastics factory, where patients belonged to the low-income group. Hence, only 18% of patients had middle or high SES. Although employment itself does not seem to be a risk factor, there is some evidence that the combination of jobs and a family may increase hypertension and CHD incidence in women. In two studies, the Framingham study [90, 91] and the Minnesota Heart Survey, [92] working women reported greater levels of stress than working men or homemakers. A similar observation was found in the female participants in the present study. Many study participants were rotational factory shift workers, including working days, afternoon, and night shifts. Blood pressure elevation effects appear to be mainly mediated by maladaptive or unhealthy coping behaviors such as excessive consumption (food, cigarettes

#### *Stress-induced Anger and Hypertension: An Evaluation of the Effects of Homeopathic… DOI: http://dx.doi.org/10.5772/intechopen.104589*

or bidis, gutka, and alcohol) and physical inactivity. These inconclusive results may have resulted partly from lifestyle differences in the study populations and have been strongly influenced by different perceptions of overwork and stress. It was found that psychological stress was associated with age, sex, and socioeconomic status. In addition, higher stress levels at work were found but lower levels of financial stress among persons with high versus low levels of income or education in both men and women. It was observed that blood pressure was explicitly related to job control (lower control linked to higher pressure) and perceived stress on the job. Participants with higher socioeconomic status and women were more stressed by low job control than men and people with lower socioeconomic status (SES). Women and young adults reported higher psychological stress levels, particularly at work, which raised age-and sex-related job strain issues with high demand and low control at work [34, 35].

A correlation between anger and hypertension (**Table 8**) was examined. The finding that none of the anger measures was associated with resting BP in this study is consistent with literature reviews on anger and hypertension [93–95]. In addition, previous reviews have found only low and inconsistent associations between trait anger and HT [96–98].

All homeopathic medicines alter the state of mind and disposition in their peculiar way [99]. Therefore, the changes in the patient's state of mind and disposition must be considered and matched with the particular homeopathic remedy that can produce a similar state in a healthy human being. As a result, permanent relief from the disease can occur. Furthermore, this ability to make distinctions among patients and superficially similar disease processes – that is, to "individualize" every case – is the natural result of the concern for the whole person, which lies at the core of homeopathic practice."

The study results also showed a reduction in anger in the control group, which was statistically significant but not as much as the reduction of anger variables in the treatment group, suggesting rapport building, up-front collaborative agenda-setting, and acknowledging social and emotional concerns as done during homeopathic case taking may help improve quality of care and efficiency. The consultation process's therapeutic benefits on health outcomes in conventional medicine and CAM have been depicted in various studies [78, 80]. These contextual effects include not the treatment's active components but are inherent within the whole treatment package such as the doctor–patient relationship, rapport-building and relationship maintenance, empathic response to social and emotional cues and mindfulness [100–105]). Research into homeopathic consultation has identified contextual factors such as empathy and empowerment [106], which may mediate the homeopathic therapeutic effect. Homeopathy consultations involve a complete exploration of the patient's emotional, spiritual, and physical wellbeing to enable the whole person's treatment, not just the illness.

Our consultation process was standardized in that specific topics were covered (e.g., detailed clinical history, current symptoms and medication, assessment of emotional and mental states, etc.) to identify the relevant information to prescribe. The consultations' content varied between patients and between consultations; homeopathic intervention was individualized and patient-centered and led by the patient's narratives.

The findings confirm previous work demonstrating that therapeutic benefits arise from inquiries within the homeopathic interview which includes communication skills, empathy, hopefulness, enablement, and narrative competence [82–84].

Homeopathic consultation necessitates a detailed understanding of the patient and is a unique and personalized approach. Therefore, the placebo effects of the homeopathic consultation may be specific to this therapy, possibly dependent on the process of the collaborative and highly individualized consultation imperative to find a homeopathic remedy and the associated symbolic meaning response for that patient [102].

During regular follow-ups every 2 weeks, there was no adverse reaction reported to homeopathic medicine in any study participants in the intervention group, proving the safety of the individualized medicine prescribed to the patients.
