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Not all posttraumatic stress disorder symptoms are equal: fear, dysphoria, and risk of developing hypertension in trauma-exposed women

Published online by Cambridge University Press:  04 January 2019

Jennifer A. Sumner Open the ORCID record for Jennifer A. Sumner [Opens in a new window] ,
Laura D. Kubzansky ,
Andrea L. Roberts ,
Qixuan Chen ,
Eric B. Rimm  and
Karestan C. Koenen
Jennifer A. Sumner*
Affiliation:
Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA
Laura D. Kubzansky
Affiliation:
Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
Andrea L. Roberts
Affiliation:
Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
Qixuan Chen
Affiliation:
Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
Eric B. Rimm
Affiliation:
Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
Karestan C. Koenen
Affiliation:
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA Psychiatric and Neurodevelopmental Genetics Unit and Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
*
Author for correspondence: Jennifer A. Sumner, E-mail: js4456@cumc.columbia.edu
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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.

Keywords

Dysphoriafearhigh blood pressurehypertensionposttraumatic stress disordertraumawomen
Type
Original Articles
Information
Psychological Medicine , Volume 50 , Issue 1 , January 2020 , pp. 38 - 47
Copyright
Copyright © Cambridge University Press 2019 

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