title: Newly reported hypertension after military combat deployment in a large population-based study.
abstract: High-stress situations, such as combat deployments, are a potential risk factor for hypertension. Although stress is postulated to increase blood pressure, the underlying role of stress on hypertension is not well established. We sought to determine the relations between combat deployment-induced stress and hypertension. The Millennium Cohort baseline questionnaire (2001-2003) was completed by 77,047 US active-duty and Reserve/National Guard members. Follow-up was completed by 55,021 responders approximately 3 years later (2004-2006). Multivariable logistic regression was used to estimate the 3-year risk of newly reported hypertension, adjusting for general and mental health, demographics, and occupational and behavioral characteristics. After applying exclusion criteria, our analyses included 36 061 service members. Subanalyses of deployers included 8829 participants. Newly reported hypertension was identified in 6.9% of the cohort between baseline and follow-up, many of whom had deployed on military operations in support of the conflicts in Iraq and Afghanistan. After adjusting, deployers who experienced no combat exposures were less likely to report hypertension than nondeployers (odds ratio: 0.77; 95% CI: 0.67 to 0.89). Among deployers, those reporting multiple combat exposures were 1.33 times more likely to report hypertension compared with noncombat deployers (95% CI: 1.07 to 1.65). Although military deployers, in general, had a lower incidence of hypertension than nondeployers, deployment with multiple stressful combat exposures appeared to be a unique risk factor for newly reported hypertension.
authors.affiliation: Department of Defense Center for Deployment Health Research, Naval Health Research Center, San Diego, CA 92106-3521, USA. nisara.granado@med.navy.mil
authors.forename: Nisara S
authors.initials: NS
authors.lastname: Granado
authors.forename: Tyler C
authors.initials: TC
authors.lastname: Smith
authors.forename: G Marie
authors.initials: GM
authors.lastname: Swanson
authors.forename: Robin B
authors.initials: RB
authors.lastname: Harris
authors.forename: Eyal
authors.initials: E
authors.lastname: Shahar
authors.forename: Besa
authors.initials: B
authors.lastname: Smith
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Boyko
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Wells
authors.forename: Margaret A K
authors.initials: MA
authors.lastname: Ryan
mesh_terms: D000328:Adult; D017677:Age Distribution; D002140:California / Q000453:epidemiology; D015331:Cohort Studies; D003130:Combat Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D008889:Military Personnel / Q000523:psychology / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D015995:Prevalence; D011336:Probability; D012016:Reference Values; D012307:Risk Factors; D012720:Severity of Illness Index; D017678:Sex Distribution; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D013315:Stress, Psychological / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D013997:Time Factors; D014481:United States; D014857:Warfare; D055815:Young Adult