Severe combat wounds, PTSD tied to high blood pressure

Members of the military who received severe combat wounds and have chronic post-traumatic stress disorder (PTSD) have an amplified risk of high blood pressure as well, according to a US Veterans Affairs study.

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 US 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 US 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.

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.