Citation

Howard JT, Sosnov JA, Janak JC, Gundlapalli AV, Pettey WB, Walker LE, Stewart IJ. Hypertension 2018; 71(5): 824-832.

Affiliation

From the Department of Defense Joint Trauma System (J.T.H., J.C.J.) and San Antonio Military Medical Center (J.A.S.), Joint Base San Antonio-Fort Sam Houston, TX; Veteran's Affairs Salt Lake City Health Care System, Informatics, Decision Enhancement, and Analytic Sciences (IDEAS 2.0) Center, UT (A.V.G., W.B.P.); Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City (A.V.G., W.B.P.); Clinical Investigation Facility, David Grant USAF Medical Center, Travis Air Force Base, CA (L.E.W., I.J.S.); and Uniformed Services University of Health Sciences, Bethesda, MD (J.A.S., I.J.S.). ian.j.stewart6.mil@mail.mil.

Copyright

(Copyright © 2018, American Heart Assn)

DOI

10.1161/HYPERTENSIONAHA.117.10496

PMID

29555664

Abstract

The associations between injury severity, posttraumatic stress disorder (PTSD), and development of chronic diseases, such as hypertension, among military service members are not understood. We sought to (1) estimate the prevalence and incidence of PTSD within a severely injured military cohort, (2) assess the association between the presence and chronicity of PTSD and hypertension, and (3) determine whether or not initial injury severity score and PTSD are independent risk factors for hypertension. Administrative and clinical databases were used to conduct a retrospective cohort study of 3846 US military casualties injured in the Iraq and Afghanistan conflicts between February 1, 2002, and February 1, 2011. Development of PTSD and hypertension after combat injury were determined using theInternational Classification of Diseases,Ninth Revisioncodes. Multivariable competing risk regression models were used to assess associations between injury severity score, PTSD, and hypertension, while controlling for covariates. Overall prevalence of PTSD was 42.4%, and prevalence of hypertension was 14.3%. Unadjusted risk of hypertension increased significantly with chronicity of PTSD (1-15 diagnoses: hazard ratio, 1.77; 95% confidence interval, 1.46-2.14;P<0.001; >15 diagnoses: hazard ratio, 2.29; 95% confidence interval, 1.85-2.84;P<0.001) compared with patients never diagnosed with PTSD. The association between injury severity score (hazard ratio, 1.06 per 5-U increment; 95% confidence interval, 1.03-1.10;P<0.001) and hypertension was significant, with little change in effect in the multivariable model (hazard ratio, 1.05 per 5-U increment; 95% confidence interval, 1.01-1.09;P=0.03). In a cohort of service members injured in combat, we found that chronicity of PTSD diagnoses and injury severity were independent risk factors for hypertension.

© 2018 American Heart Association, Inc.

Language: en

Keywords

humans; hypertension; injury severity score; stress disorders, post-traumatic; wounds and injuries