**5. Materials and methods**

This trial was randomized, placebo-controlled, comparative, and open-label conducted at an urban and a rural charitable homoeopathic hospital and a plastic factory. About 1187 adults were screened for hypertension. They were asked about the history of hypertension as well. We found 303 patients with either history of hypertension or were detected with hypertension during screening on BP measurements. The screening was carried out at a rural and an urban charitable hospital and a plastic factory. Secondary hypertension was ruled out among these 303 hypertensive patients by checking routine blood biochemistry, Ultrasonography (USG), electrocardiogram (ECG), and x-ray chest. However, eight patients were found to have secondary causes like renal artery stenosis, Conn's syndrome, coarctation of the aorta; these patients were excluded from moving into the study. One-hundred and seventy-two patients (108 males and 64 females) between 18 and 65 years who gave their informed, voluntary consent were enrolled in the study as per the approval from the ethics committee of Dr. M.L. Dhawale Memorial Homoeopathic Institute's approval. By simple randomization, they were allocated their respective groups, i.e., placebo and intervention groups. More than 50% of patients in both groups were on Antihypertensives prescribed by the physician at the beginning of the study.

All the patients were given necessary lifestyle management advice, also suggested a dietary approach to stop hypertension (DASH diet) [89] and regular exercises. Thorough homeopathic case-taking was done, and the STAXI-2 scale was applied at the beginning and after a 6-months study period to measure the change in anger for all the patients. Every 2 weeks, these patients were followed up for subjective criteria like anger, anger episodes, fights, and moods. Also, objective criteria were assessed like BP, pulse rate, physical complaints. Regular follow-up was done every 2 weeks to check all the patients' subjective and objective parameters.

Data were entered in MS Excel and then transferred to SPSS SW V. 21 for analysis. The quantitative data were represented as mean SD & compared using Student's *t*-test. In addition, a Pearson correlation test was performed to find correlations between variables.

### **5.1 STAXI-2**

Spielberger's State-Trait Anger Expression Inventory-2 (STAXI-2) is a measure of anger experience and expression used to assess aggression and violence, given the close association between anger dysregulation and aggressive and violent behavior. The STAXI-2 is one of the most widely used measures in clinical and research settings (**Table 1**) [56].


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


**Table 1.**

*Brief overview of the STAXI-2 scales and subscales.*

It calculates the experience and expression of anger and is a 57-item self-report questionnaire. It consists of six scales and an anger expression index. It is a widely used scale for assessment, with the following dimensions:

State anger (S-Ang): the intensity of angry feelings at the time of completion; Trait anger (T-Ang): a disposition to experience anger;

Anger Expression-Out (Ax-O): the expression of angry feelings out;

Anger Expression-In (AX-I): the suppression of angry feelings;

Anger Control-Out (AC-O): the prevention of anger expression toward other people or objects;

Anger Control-In (AC-I): the control of suppressed anger and

Anger Expression Index (AX-index): an overall index of the frequency of anger expression, regardless of direction.
