Background: Numerous risk factors have been involved in the pathogenesis of hypertension. The contribution of psychological factors, including post-traumatic stress disorder, remains largely underexplored, despite their potential role in hypertension.Objectives: We compared the prevalence of trauma, posttraumatic stress and other psychological disorders between hypertensive and normotensive patients from Bukavu (Democratic Republic of Congo), a 25-year war-exposed city.
Methods and measures:In this case-control study, we assessed past traumatic events with the Stressful-Events-Scale, post-traumatic stress disorder through the posttraumatic diagnostic scale, depression and alcohol use disorder through the MINI-International-Neuropsychiatric-Interview, and emotion regulation through the Emotion-Regulation-Questionnaire in 106 hypertensive and 106 normotensive patients, enrolled at the Bukavu General Hospital.Results: Compared with normotensive controls (73% women, age: 43 AE 14 years, BP: 121 AE 10/75 AE 8 mmHg), hypertensive patients (57% women, age: 42 AE 13 years, BP: 141 AE 12/82 AE 7 mmHg, on a median of two antihypertensive drugs) were exposed to more man-made traumas (61 vs. 13%, P < 0.001), used more expressive suppression (P ¼ 0.05) and less cognitive reappraisal (P ¼ 0.02) as emotional regulation strategies. They developed more frequent post-traumatic stress disorder (36 vs. 7%, P < 0.001) and major depressive disorder (37 vs. 13%, P ¼ 0.001), often in association with alcohol use disorder (23 vs. 4%, P < 0.001). In multivariate logistic regression, post-traumatic stress disorder [OR ¼ 3.52 (1.23-6.54)], man-made trauma [OR ¼ 2.24 (1.15-4.12)], family history of hypertension ], fasting blood glucose [OR ¼ 1.85 (1.07-3.08)], BMI [OR ¼ 1.28 (1.12-2.92)], expressive suppression ] and cognitive reappraisal [OR ¼ 0.76 (0.63-0.98)] were independent predictors of hypertension.
Conclusion:In Congolese populations exposed to war, man-made trauma exposure and post-traumatic stress disorder appear to be more tightly related to hypertension than classical hypertension risk factors.