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Post-traumatic stress disorder symptoms and risk of hypertension over 22 years in a large cohort of younger and middle-aged women

Published online by Cambridge University Press:  18 August 2016

J. A. Sumner ,
L. D. Kubzansky ,
A. L. Roberts ,
P. Gilsanz ,
Q. Chen ,
A. Winning ,
J. P. Forman ,
E. B. Rimm  and
K. C. Koenen
J. A. Sumner*
Affiliation:
Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
L. D. Kubzansky
Affiliation:
Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA
A. L. Roberts
Affiliation:
Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA
P. Gilsanz
Affiliation:
Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA
Q. Chen
Affiliation:
Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
A. Winning
Affiliation:
Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA
J. P. Forman
Affiliation:
Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
E. B. Rimm
Affiliation:
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
K. C. Koenen
Affiliation:
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA Psychiatric and Neurodevelopmental Genetics Unit and Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
*
*Address for correspondence: J. A. Sumner, Ph.D., Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W.168th St, PH9-315, New York, NY 10032, USA. (Email: js4456@cumc.columbia.edu)
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Abstract

Background

Post-traumatic stress disorder (PTSD) has been linked to hypertension, but most research on PTSD and hypertension is cross-sectional, and potential mediators have not been clearly identified. Moreover, PTSD is twice as common in women as in men, but understanding of the PTSD-hypertension relationship in women is limited. We examined trauma exposure and PTSD symptoms in relation to incident hypertension over 22 years in 47 514 civilian women in the Nurses’ Health Study II.

Method

We used proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for new-onset hypertension (N = 15 837).

Results

PTSD symptoms assessed with a screen were modestly associated with incident hypertension in a dose-response fashion after adjusting for potential confounders. Compared to women with no trauma exposure, women with 6–7 PTSD symptoms had the highest risk of developing hypertension (HR 1.20, 95% CI 1.12–1.30), followed by women with 4–5 symptoms (HR 1.17, 95% CI 1.10–1.25), women with 1–3 symptoms (HR 1.12, 95% CI 1.06–1.18), and trauma-exposed women with no symptoms (HR 1.04, 95% CI 1.00–1.09). Findings were maintained, although attenuated, adjusting for hypertension-relevant medications, medical risk factors, and health behaviors. Higher body mass index and antidepressant use accounted for 30% and 21% of the PTSD symptom-hypertension association, respectively.

Conclusions

Screening for hypertension and reducing unhealthy lifestyle factors, particularly obesity, in women with PTSD may hold promise for offsetting cardiovascular risk.

Keywords

Epidemiologyhypertensionpost-traumatic stress disordertraumawomen
Type
Original Articles
Information
Psychological Medicine , Volume 46 , Issue 15 , November 2016 , pp. 3105 - 3116
Copyright
Copyright © Cambridge University Press 2016 

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