Hypertension in Relation to Posttraumatic Stress Disorder and Depression in the US National Comorbidity Survey

Abstract

The clinical literature increasingly indicates that cardiovascular risk factors and cardiovascular disease (CVD) are more common among individuals with posttraumatic stress disorder (PTSD). Depression also poses a risk for CVD and is often comorbid with PTSD. Research to date has not established whether PTSD is associated with additional CVD risk beyond the risks associated with comorbid depression. The authors examined relationships of lifetime PTSD and depression with high blood pressure in data from the US National Comorbidity Survey. They divided participants into 4 mutually exclusive diagnostic groups: (1) PTSD history and no depression history, (2) PTSD and depression history, (3) depression history and no PTSD history, and (4) no history of mental disorder. Hypertension prevalence was higher for the PTSD, no depression and PTSD plus depression groups compared with the depression only and no mental disorder groups. PTSD appears to be related to hypertension independent of depression. This may partially explain elevated rates of CVD in PTSD patients.

Posttraumatic Stress Disorder and Cardiometabolic Disease

“…PTSD patients have significantly higher diastolic blood pressure compared with patients afflicted by other psychiatric disorders [89]. Data from the US National Comorbidity Survey suggest PTSD to be related to hypertension independently of depression [177]. …”

Autonomic and inflammatory consequences of posttraumatic stress disorder and the link to cardiovascular disease

“…Data from the U.S. National Comorbidity Survey showed that people with PTSD had a 2.9-fold greater risk for developing hypertension (51). In a sample of more than 300,000 veterans of the Iraq and Afghanistan wars, those with PTSD had a 59% higher chance of developing hypertension compared with those without PTSD (19).…”

“…Moreover, in the Framingham Coronary Heart Disease study, patients with PTSD were found to have increased Framingham risk scores for CVD (40). To date, there have been six PTSD-CVD prospective studies completed, following participants from 1 to 30 years, which have demonstrated consistent associations between PTSD and CVD after adjusting for demographic, clinical, and psychosocial factors, including depression (15,44,57,58,89,96).There are multiple risk factors (stroke, hypertension, atherosclerosis, and obesity metabolic syndrome) for the development of CVD, and increases in the incidence of these risk factors are often associated with PTSD (1,22,30,51,111 In a 14-year prospective study of more than 1,900 patients, men had an increased risk for both nonfatal myocardial infarction and fatal coronary heart disease with every SD increase in symptom level; similarly, women with five or more PTSD symptoms had over three times the risk of incidence of CVD (57, 58). It is also worth noting that clinically significant PTSD symptoms can be induced by cardiovascular related events, and these individuals are more likely to have recurrent major adverse coronary events (24, 59).…”

“…There are multiple risk factors (stroke, hypertension, atherosclerosis, and obesity metabolic syndrome) for the development of CVD, and increases in the incidence of these risk factors are often associated with PTSD (1,22,30,51,111 In a 14-year prospective study of more than 1,900 patients, men had an increased risk for both nonfatal myocardial infarction and fatal coronary heart disease with every SD increase in symptom level; similarly, women with five or more PTSD symptoms had over three times the risk of incidence of CVD (57, 58). It is also worth noting that clinically significant PTSD symptoms can be induced by cardiovascular related events, and these individuals are more likely to have recurrent major adverse coronary events (24, 59).…”

Veterans of Combat

“…This is particularly important, because both hypertension and hyperlipidemia have been associated with PTSD. 19,20 Although PTSD did not explain the entire impact of combat on cardiovascular risk, it does appear to have at least some mediating role. Several modalities for PTSD treatment have been shown to reduce symptoms.…”