Jennifer A Sumner1, Laura D Kubzansky2, Andrea L Roberts3, Qixuan Chen4, Eric B Rimm5,6,7, Karestan C Koenen7,8. 1. Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA. 2. Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA. 3. Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA. 4. Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA. 5. Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. 6. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA. 7. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. 8. Psychiatric and Neurodevelopmental Genetics Unit and Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
Abstract
BACKGROUND: Posttraumatic stress disorder (PTSD) is associated with higher risk of incident hypertension, but it is unclear whether specific aspects of PTSD are particularly cardiotoxic. PTSD is a heterogeneous disorder, comprising dimensions of fear and dysphoria. Because elevated fear after trauma may promote autonomic nervous system dysregulation, we hypothesized fear would predict hypertension onset, and associations with hypertension would be stronger with fear than dysphoria. METHODS: We examined fear and dysphoria symptom dimensions in relation to incident hypertension over 24 years in 2709 trauma-exposed women in the Nurses' Health Study II. Posttraumatic fear and dysphoria symptom scores were derived from a PTSD diagnostic interview. We used proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for each symptom dimension (quintiles) with new-onset hypertension events (N = 925), using separate models. We also considered lower-order symptom dimensions of fear and dysphoria. RESULTS: Higher levels of fear (P-trend = 0.02), but not dysphoria (P-trend = 0.22), symptoms were significantly associated with increased hypertension risk after adjusting for socio-demographics and family history of hypertension. Women in the highest v. lowest fear quintile had a 26% higher rate of developing hypertension [HR = 1.26 (95% CI 1.02-1.57)]; the increased incidence associated with greater fear was similar when further adjusted for biomedical and health behavior covariates (P-trend = 0.04) and dysphoria symptoms (P-trend = 0.04). Lower-order symptom dimension analyses provided preliminary evidence that the re-experiencing and avoidance components of fear were particularly associated with hypertension. CONCLUSIONS: Fear symptoms associated with PTSD may be a critical driver of elevated cardiovascular risk in trauma-exposed individuals.
BACKGROUND:Posttraumatic stress disorder (PTSD) is associated with higher risk of incident hypertension, but it is unclear whether specific aspects of PTSD are particularly cardiotoxic. PTSD is a heterogeneous disorder, comprising dimensions of fear and dysphoria. Because elevated fear after trauma may promote autonomic nervous system dysregulation, we hypothesized fear would predict hypertension onset, and associations with hypertension would be stronger with fear than dysphoria. METHODS: We examined fear and dysphoria symptom dimensions in relation to incident hypertension over 24 years in 2709 trauma-exposed women in the Nurses' Health Study II. Posttraumatic fear and dysphoria symptom scores were derived from a PTSD diagnostic interview. We used proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for each symptom dimension (quintiles) with new-onset hypertension events (N = 925), using separate models. We also considered lower-order symptom dimensions of fear and dysphoria. RESULTS: Higher levels of fear (P-trend = 0.02), but not dysphoria (P-trend = 0.22), symptoms were significantly associated with increased hypertension risk after adjusting for socio-demographics and family history of hypertension. Women in the highest v. lowest fear quintile had a 26% higher rate of developing hypertension [HR = 1.26 (95% CI 1.02-1.57)]; the increased incidence associated with greater fear was similar when further adjusted for biomedical and health behavior covariates (P-trend = 0.04) and dysphoria symptoms (P-trend = 0.04). Lower-order symptom dimension analyses provided preliminary evidence that the re-experiencing and avoidance components of fear were particularly associated with hypertension. CONCLUSIONS: Fear symptoms associated with PTSD may be a critical driver of elevated cardiovascular risk in trauma-exposed individuals.
Entities:
Keywords:
Dysphoria; fear; high blood pressure; hypertension; posttraumatic stress disorder; trauma; women
Authors: Ahmed Tawakol; Amorina Ishai; Richard Ap Takx; Amparo L Figueroa; Abdelrahman Ali; Yannick Kaiser; Quynh A Truong; Chloe Je Solomon; Claudia Calcagno; Venkatesh Mani; Cheuk Y Tang; Willem Jm Mulder; James W Murrough; Udo Hoffmann; Matthias Nahrendorf; Lisa M Shin; Zahi A Fayad; Roger K Pitman Journal: Lancet Date: 2017-01-12 Impact factor: 79.321
Authors: Nisara S Granado; Tyler C Smith; G Marie Swanson; Robin B Harris; Eyal Shahar; Besa Smith; Edward J Boyko; Timothy S Wells; Margaret A K Ryan Journal: Hypertension Date: 2009-09-14 Impact factor: 10.190
Authors: Natalie Mota; Jennifer A Sumner; Sarah R Lowe; Alexander Neumeister; Monica Uddin; Allison E Aiello; Derek E Wildman; Sandro Galea; Karestan C Koenen; Robert H Pietrzak Journal: J Clin Psychiatry Date: 2015-12 Impact factor: 4.384
Authors: Ronald C Kessler; Patricia Berglund; Olga Demler; Robert Jin; Kathleen R Merikangas; Ellen E Walters Journal: Arch Gen Psychiatry Date: 2005-06
Authors: Jeffrey T Howard; Jonathan A Sosnov; Jud C Janak; Adi V Gundlapalli; Warren B Pettey; Lauren E Walker; Ian J Stewart Journal: Hypertension Date: 2018-03-19 Impact factor: 10.190
Authors: K C Koenen; J A Sumner; P Gilsanz; M M Glymour; A Ratanatharathorn; E B Rimm; A L Roberts; A Winning; L D Kubzansky Journal: Psychol Med Date: 2016-10-04 Impact factor: 7.723
Authors: Roger K Pitman; Ann M Rasmusson; Karestan C Koenen; Lisa M Shin; Scott P Orr; Mark W Gilbertson; Mohammed R Milad; Israel Liberzon Journal: Nat Rev Neurosci Date: 2012-10-10 Impact factor: 34.870
Authors: Jennifer A Sumner; Adam X Maihofer; Vasiliki Michopoulos; Alex O Rothbaum; Lynn M Almli; Ole A Andreassen; Allison E Ashley-Koch; Dewleen G Baker; Jean C Beckham; Bekh Bradley; Gerome Breen; Jonathan R I Coleman; Anders M Dale; Michelle F Dennis; Norah C Feeny; Carol E Franz; Melanie E Garrett; Charles F Gillespie; Guia Guffanti; Michael A Hauser; Sian M J Hemmings; Tanja Jovanovic; Nathan A Kimbrel; William S Kremen; Bruce R Lawford; Mark W Logue; Adriana Lori; Michael J Lyons; Jessica Maples-Keller; Matig R Mavissakalian; Regina E McGlinchey; Divya Mehta; Rebecca Mellor; William Milberg; Mark W Miller; Charles Phillip Morris; Matthew S Panizzon; Kerry J Ressler; Victoria B Risbrough; Barbara O Rothbaum; Peter Roy-Byrne; Soraya Seedat; Alicia K Smith; Jennifer S Stevens; Leigh Luella van den Heuvel; Joanne Voisey; Ross McD Young; Lori A Zoellner; Caroline M Nievergelt; Erika J Wolf Journal: Front Neurosci Date: 2021-06-23 Impact factor: 4.677