Risk for Incident Hypertension Associated With Posttraumatic Stress Disorder in Military Veterans and the Effect of Posttraumatic Stress Disorder Treatment.
Risk for Incident Hypertension Associated With Posttraumatic Stress Disorder in Military Veterans and the Effect of Posttraumatic Stress Disorder Treatment.
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DOI：
10.1097/psy.0000000000000376
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发表时间：
2017
影响因子：
3.3
通讯作者：
Haskell S
中科院分区：
文献类型：
--
作者：
Burg MM;Brandt C;Buta E;Schwartz J;Bathulapalli H;Dziura J;Edmondson DE;Haskell S
创伤后应激障碍会增加心血管疾病和心血管死亡的风险。创伤后应激障碍与高血压发病风险的预期关系，以及创伤后应激障碍治疗对高血压风险的影响都尚未确定。具有全国代表性的194,319名退伍军人样本的数据来自美国退伍军人管理局的男女服役人员名册。这包括退伍军人，他们的最后一次部署结束是在2001年9月至2010年7月，他们的第一次退伍军人医疗访问是在2001年10月1日至2009年1月1日。高血压事件被建模为3个事件：1)高血压的新诊断；和/或2)降压药物的新处方；和/或3)临床血压读数在高血压范围内(≥140 mm Hg/90 mm Hg，收缩/舒张期)。创伤后应激障碍的诊断是主要的预测因素。创伤后应激障碍的治疗被定义为：1)在任何连续6个月内至少8次≥50min的个人心理治疗和/或2)SSRI药物处方。在中位数2.4年的随访期内，与创伤后应激障碍独立相关的高血压事件风险从HR=1.12(95%可信区间1.08-1.17，p<；0.0001)到HR=1.3(95%可信区间1.26-1.34，p<；0.0001)。创伤后应激障碍与治疗的交互作用表明，治疗降低了创伤后应激障碍相关高血压的风险(例如，对于未接受治疗的患者，HR=1.44[95%可信区间1.38-1.50，p<；0.0001]，对于接受治疗的患者，HR=1.2[95%CI 1.15-1.25，p<；0.0001])。这些结果表明，要减少创伤后应激障碍对健康的长期影响和相关成本，可能需要非常早期的监测和治疗。
PTSD increases cardiovascular disease and cardiovascular mortality risk. Neither the prospective relationship of PTSD to incident hypertension risk, nor the effect of PTSD treatment on hypertension risk has been established. Data from a nationally representative sample of 194,319 veterans were drawn from the Veterans Administration roster of United States service men and women. This included veterans whose end of last deployment was from September 2001 – July 2010, and whose first VA medical visit was from October 1, 2001 – January 1, 2009. Incident hypertension was modeled as 3 events: 1) a new diagnosis of hypertension; and/or 2) a new prescription for anti-hypertensive medication; and/or 3) a clinic BP reading in the hypertensive range (≥140mmHg/90mmHg, systolic/diastolic). PTSD diagnosis was the main predictor. PTSD treatment was defined as, 1) at least 8 individual psychotherapy sessions of ≥ 50min during any consecutive 6 months and/or 2) a prescription for SSRI medication. Over a median 2.4 year follow-up, the incident hypertension risk independently associated with PTSD ranged from HR=1.12 (95% CI 1.08 – 1.17, p<0.0001) to HR=1.30 (95% CI 1.26 – 1.34, p<0.0001). The interaction of PTSD and treatment revealed that treatment reduced the PTSD associated hypertension risk (e.g., from HR=1.44 [95% CI 1.38 – 1.50, p<0.0001] for those untreated, to HR=1.20 [95% CI 1.15 – 1.25, p<0.0001] for those treated). These results indicate that reducing the long term health impact of PTSD and the associated costs, may require very early surveillance and treatment.