In the Journals

PTSD after injury increases risk for hypertension in military service members

Ian J. Stewart

Injury severity and PTSD were independent risk factors for hypertension in military service members and those injured in combat, according to a study published in Hypertension.

“What we found surprised us,” Ian J. Stewart, MD, of the clinical investigation facility at David Grant USAF Medical Center on Travis Air Force Base in California, said in a press release. “PTSD does appear to increase the risk of hypertension, but we thought that hypertension risk from the injury would depend on the presence of PTSD. Instead, increased hypertension risk is additive to the injury itself.”

Injured military service members

Jeffrey T. Howard, PhD, epidemiologist at the Department of Defense Joint Trauma System at Joint Base San Antonio-Fort Sam Houston, and colleagues analyzed data from 3,846 patients (mean age at time of injury, 26 years; 98% men) who were U.S. military service members and injured in combat during the Afghanistan or Iraq conflicts between 2002 and 2011. Patients were severely injured and required admission to an ICU. Those with hypertension before their injury were excluded.

Injury severity was determined by a validated scoring system based on anatomic structures and body regions. The score ranged from 1 to 75.

The incidence of hypertension and PTSD were monitored for a median of 4 years by administrative databases.

During follow-up, 42.4% of patients developed PTSD and 14.3% had hypertension.

Compared with patients without PTSD, the unadjusted risk for hypertension increased in both patients with one to 15 PTSD diagnosis encounters (HR = 1.77; 95% CI, 1.46-2.14) and was more pronounced in those with more than 15 encounters (HR = 2.29; 95% CI, 1.85-2.84).

The risk for hypertension increased by 6% with each 5-point increase in the injury severity score (HR = 1.06; 95% CI, 1.03-1.1). Results were similar after adjusting for the total number of non-PTSD encounters (HR = 1.05; 95% CI, 1.01-1.09).

Hypertension risk factors

After adjustment, factors that were significantly associated with hypertension included black race (HR = 1.69; 95% CI, 1.25-2.29), age (HR = 1.05; 95% CI, 1.04-1.07), acute kidney injury (HR = 1.35; 95% CI, 1.05-1.74) and high mean arterial pressure (HR = 1.39; 95% CI, 1.1-1.75).

“Although these results do not completely rule out mental health as a pathway, they suggest that more attention must be paid to the possibility that the [injury severity score]-hypertension association may operate through inflammatory, behavioral or other pathways,” Howard and colleagues wrote.

“The work of Howard et al strengthens the claim that psychological support should be an integral part of the management of some forms of hypertension,” Alexandre Persu, MD, PhD, head of the hypertension clinic in the cardiology department at Cliniques Universitaire Saint-Luc in Brussels, and colleagues wrote in a related editorial. “As such, beyond its specific teachings for prevention and management of hypertension and cardiovascular complications in military servants, it may help hypertension specialists and more generally all physicians involved in the diagnosis and treatment of this deadly, still uncontrolled disease named hypertension to widen their perspective and incorporate psychological approaches in their armamentarium.” – by Darlene Dobkowski

Disclosures: The study was supported by the U.S. Air Force, Headquarters, Office of the Surgeon General. Howard, Stewart and Persu report no relevant financial disclosures.

Ian J. Stewart

Injury severity and PTSD were independent risk factors for hypertension in military service members and those injured in combat, according to a study published in Hypertension.

“What we found surprised us,” Ian J. Stewart, MD, of the clinical investigation facility at David Grant USAF Medical Center on Travis Air Force Base in California, said in a press release. “PTSD does appear to increase the risk of hypertension, but we thought that hypertension risk from the injury would depend on the presence of PTSD. Instead, increased hypertension risk is additive to the injury itself.”

Injured military service members

Jeffrey T. Howard, PhD, epidemiologist at the Department of Defense Joint Trauma System at Joint Base San Antonio-Fort Sam Houston, and colleagues analyzed data from 3,846 patients (mean age at time of injury, 26 years; 98% men) who were U.S. military service members and injured in combat during the Afghanistan or Iraq conflicts between 2002 and 2011. Patients were severely injured and required admission to an ICU. Those with hypertension before their injury were excluded.

Injury severity was determined by a validated scoring system based on anatomic structures and body regions. The score ranged from 1 to 75.

The incidence of hypertension and PTSD were monitored for a median of 4 years by administrative databases.

During follow-up, 42.4% of patients developed PTSD and 14.3% had hypertension.

Compared with patients without PTSD, the unadjusted risk for hypertension increased in both patients with one to 15 PTSD diagnosis encounters (HR = 1.77; 95% CI, 1.46-2.14) and was more pronounced in those with more than 15 encounters (HR = 2.29; 95% CI, 1.85-2.84).

The risk for hypertension increased by 6% with each 5-point increase in the injury severity score (HR = 1.06; 95% CI, 1.03-1.1). Results were similar after adjusting for the total number of non-PTSD encounters (HR = 1.05; 95% CI, 1.01-1.09).

Hypertension risk factors

After adjustment, factors that were significantly associated with hypertension included black race (HR = 1.69; 95% CI, 1.25-2.29), age (HR = 1.05; 95% CI, 1.04-1.07), acute kidney injury (HR = 1.35; 95% CI, 1.05-1.74) and high mean arterial pressure (HR = 1.39; 95% CI, 1.1-1.75).

“Although these results do not completely rule out mental health as a pathway, they suggest that more attention must be paid to the possibility that the [injury severity score]-hypertension association may operate through inflammatory, behavioral or other pathways,” Howard and colleagues wrote.

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“The work of Howard et al strengthens the claim that psychological support should be an integral part of the management of some forms of hypertension,” Alexandre Persu, MD, PhD, head of the hypertension clinic in the cardiology department at Cliniques Universitaire Saint-Luc in Brussels, and colleagues wrote in a related editorial. “As such, beyond its specific teachings for prevention and management of hypertension and cardiovascular complications in military servants, it may help hypertension specialists and more generally all physicians involved in the diagnosis and treatment of this deadly, still uncontrolled disease named hypertension to widen their perspective and incorporate psychological approaches in their armamentarium.” – by Darlene Dobkowski

Disclosures: The study was supported by the U.S. Air Force, Headquarters, Office of the Surgeon General. Howard, Stewart and Persu report no relevant financial disclosures.