Elaborating the reactivity hypothesis about the development of cardiovascular disease we posit that performance conditions having strong consequences for individuals' self-definitions and self-esteem can provide a severe health risk. Based on a recent application of motivational intensity theory to self-relevant performance conditions we argue that such performance conditions justify the mobilization of high resources for active coping. The result is high effort when self-relevant demands are difficult or individuals try to do their best in active coping. Given the systematic link between resource mobilization and cardiovascular reactivity, this leads to strong cardiovascular reactivity under these conditions, which in turn promotes the development of hypertension and cardiovascular disease. The results of a recent series of studies are discussed.