Hypertension, a Posttraumatic Stress Disorder?
Time to Widen Our Perspective
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See related article, pp 824–832
Hypertension has long been suspected of being, in some patients, a psychosomatic disorder. The impact of daily exposure to life stresses, to anger, or to anxiety on high blood pressure has been studied for decades, but these works showed inconsistent results and, as such, mostly failed to confirm the underlying hypotheses.1 Nevertheless, the role of 2 specific psychological impairments in the development of hypertension is supported by stronger evidence and, as such, deserves further investigation: the repression of the expression of affects2 and the exposure to intensely traumatic life events.1
In particular, posttraumatic stress disorder (PTSD) has been associated with an increased risk of hypertension in a nationally representative US population sample of 4008 subjects (odds ratio, 2.6–2.9 according to the model),3 and cohorts of 303 223 (odds ratio, 1.6–2.9)4 and 194 319 (hazard ratio, 1.1–1.3) US veterans deployed in Iraq and Afghanistan.5 On the other hand, in 3846 wounded US military service members, Stewart et al6 reported increased incidence rates of hypertension (from 6% to 15%) according to the degree of severity of the initial injury.
In the current issue of Hypertension, Howard et al7 provide further insights into the …