title: Post-traumatic stress disorder symptoms and risk of hypertension over 22 years in a large cohort of younger and middle-aged women.
abstract: Post-traumatic stress disorder (PTSD) has been linked to hypertension, but most research on PTSD and hypertension is cross-sectional, and potential mediators have not been clearly identified. Moreover, PTSD is twice as common in women as in men, but understanding of the PTSD-hypertension relationship in women is limited. We examined trauma exposure and PTSD symptoms in relation to incident hypertension over 22 years in 47 514 civilian women in the Nurses' Health Study II.
  
  
  
  We used proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for new-onset hypertension (N = 15 837).
  
  
  
  PTSD symptoms assessed with a screen were modestly associated with incident hypertension in a dose-response fashion after adjusting for potential confounders. Compared to women with no trauma exposure, women with 6-7 PTSD symptoms had the highest risk of developing hypertension (HR 1.20, 95% CI 1.12-1.30), followed by women with 4-5 symptoms (HR 1.17, 95% CI 1.10-1.25), women with 1-3 symptoms (HR 1.12, 95% CI 1.06-1.18), and trauma-exposed women with no symptoms (HR 1.04, 95% CI 1.00-1.09). Findings were maintained, although attenuated, adjusting for hypertension-relevant medications, medical risk factors, and health behaviors. Higher body mass index and antidepressant use accounted for 30% and 21% of the PTSD symptom-hypertension association, respectively.
  
  
  
  Screening for hypertension and reducing unhealthy lifestyle factors, particularly obesity, in women with PTSD may hold promise for offsetting cardiovascular risk.
authors.affiliation: Center for Behavioral Cardiovascular Health, Columbia University Medical Center,New York, NY,USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Sumner
authors.affiliation: Department of Social and Behavioral Sciences,Harvard T. H. Chan School of Public Health,Boston, MA,USA.
authors.forename: L D
authors.initials: LD
authors.lastname: Kubzansky
authors.affiliation: Department of Social and Behavioral Sciences,Harvard T. H. Chan School of Public Health,Boston, MA,USA.
authors.forename: A L
authors.initials: AL
authors.lastname: Roberts
authors.affiliation: Department of Social and Behavioral Sciences,Harvard T. H. Chan School of Public Health,Boston, MA,USA.
authors.forename: P
authors.initials: P
authors.lastname: Gilsanz
authors.affiliation: Department of Biostatistics,Columbia University Mailman School of Public Health,New York, NY,USA.
authors.forename: Q
authors.initials: Q
authors.lastname: Chen
authors.affiliation: Department of Social and Behavioral Sciences,Harvard T. H. Chan School of Public Health,Boston, MA,USA.
authors.forename: A
authors.initials: A
authors.lastname: Winning
authors.affiliation: Renal Division,Brigham and Women's Hospital, Harvard Medical School,Boston, MA,USA.
authors.forename: J P
authors.initials: JP
authors.lastname: Forman
authors.affiliation: Department of Epidemiology,Harvard T.H. Chan School of Public Health,Boston, MA,USA.
authors.forename: E B
authors.initials: EB
authors.lastname: Rimm
authors.affiliation: Department of Epidemiology,Harvard T.H. Chan School of Public Health,Boston, MA,USA.
authors.forename: K C
authors.initials: KC
authors.lastname: Koenen
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D015994:Incidence; D008137:Longitudinal Studies; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D000067073:Psychological Trauma / Q000453:epidemiology*; D012307:Risk Factors; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*
chemical_list: D000928:Antidepressive Agents
keywords: Epidemiology; hypertension; post-traumatic stress disorder; trauma; women