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 Based on records for nearly 4,000 veterans of combat in Afghanistan
or Iraq who were treated for severe injuries and PTSD during a
nine-year period, researchers found the severity of the physical
injuries and how frequently PTSD was noted in their medical records
each affected a vet’s risk of hypertension.
The increased hypertension risk was additive and dependent on the
severity of veteran’s injuries, the study team reports in the
journal Hypertension.
“I think, if anything, this study speaks to the complexity of both
mental health diagnoses like PTSD and traditional diagnoses of
hypertension,” said senior author Major Ian J. Stewart, who works
from the David Grant U.S. Air Force Medical Center at Travis Air
Force Base in California.
“This study implies that we really have to be holistic in how we
approach and treat these patients. We have to go beyond the single
myopic vision we have and address the medical and mental aspects of
high blood pressure,” Stewart said in a telephone interview.
Post-traumatic stress disorder (PTSD) is an intense anxiety disorder
following exposure to a traumatic event that can trigger depression,
sleep problems, eating disorders and substance abuse, in addition to
physical symptoms like fast heartbeat and hypertension.
The U.S. Department of Veterans Affairs estimates that as many as 10
percent of Gulf War (Desert Storm) veterans and 11 percent of
veterans who were deployed in Afghanistan suffer from PTSD.
For the new analysis, researchers determined injury severity in
3,846 service members, 98 percent of whom were men, whose average
age was 26. About 42 percent had a PTSD diagnosis at some point
during the follow-up period and 14 percent had developed
hypertension at least 90 days after being wounded.
The study team used a scoring system ranging from 1 to 75, based on
the nature of the injury and parts of the body involved, to assess
the severity of each veteran’s physical wounds. For example, a
third-degree burn covering 20 percent of the skin surface plus a
concussion and minor scalp cut would yield a score of 11 while a 60
percent, third-degree burn plus six rib fractures would score a 41.
The study found that for every five-point increase in
injury-severity score, the overall risk of high blood pressure rose
by 5 percent.
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Separately, veterans with mild PTSD had an 85 percent higher risk of
hypertension compared to those with no PTSD diagnosis, and those
with more chronic PTSD had a 114 percent risk increase.
When veterans had 15 or more physician encounters that included a
PTSD diagnosis, they had nearly double the risk of developing high
blood pressure during a four-year follow-up compared with patients
without PTSD.
The study also found that age, acute kidney injury and race were
associated with the risk of developing hypertension. The risk of
hypertension was 69 percent higher for African Americans compared
with whites, for example.
The study team had previously found that injury severity alone was
linked to hypertension risk, and theorized that PTSD might be a
mechanism by which more-severe injuries led to high blood pressure.
But Dr. Alexandre Persu, head of the hypertension clinic at
Cliniques Universitaires Saint-Luc in Brussels, who co-wrote an
editorial accompanying the study, cautioned against applying the
study findings to all patients.
“While some knowledge of the patient’s personal history is part of
our daily job, detailed inquiry about past trauma and/or use of PTSD
questionnaires should probably be considered only in patients with
unexplained, severe, difficult to treat or treatment-resistant
hypertension . . . after the conventional approach has failed,”
Persu said in an email.
Among the study’s limitations is that it could not measure other
confounding risks for hypertension, such as inflammation, genetics
and obesity. Also, the study can only highlight associations but
cannot prove whether or how specific risk factors might cause
hypertension.
“We know hypertension is a contributing risk factor for stroke and
heart attacks but it usually goes undetected and is untreated,” said
Vincent Bufalino, president of Advocate Medical Group in Chicago and
a spokesman for the American Heart Association, who was not involved
in the research. “This study is a red flag for people to realize
that hypertension is not a fluke in these young men. We need to make
the diagnosis and treat them properly to mitigate their risk,” he
said in a phone interview.
SOURCE: https://bit.ly/2puomom and https://bit.ly/2uemnds
Hypertension, online March 19, 2018.
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