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2015 HSR&D/QUERI National Conference Abstract

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1066 — PTSD, PTSD Treatment, and Risk for Incident Hypertension in OIF/OEF/OND Veterans

Burg MM, VA Connecticut / Yale University; Brandt C, VA Connecticut / Yale University; Buta E, VA Connecticut / Yale University; Bathulapali H, VA Connecticut; Dziura J, VA Connecticut / Yale University; Haskell S, VA Connecticut / Yale University;

Objectives:
Cross-sectional and prospective studies reveal a greater independent risk for early CVD events or CVD-specific mortality associated with PTSD. In cross-sectional studies, PTSD has also been linked to hypertension. The effect of PTSD treatment on CVD risk has not been tested. We investigated the prospective relationship of PTSD to incident hypertension and tested whether evidence-based PTSD treatment attenuated hypertension risk.

Methods:
A prospective cohort study of OIF/OEF Veterans drawn from the roster of the Defense Manpower Data Center"”Contingency Tracking System Deployment File, whose end of last deployment was between Sept 2001-July 2010, whose first VA medical visit was between Oct 1, 2001-January 1, 2009, and who had at least 2 medical visits with a blood pressure measurement during the period of observation after their last deployment end date. PTSD diagnosis was determined from the health record. In 3 models, incident hypertension was defined by a new diagnosis of hypertension, new prescription for anti-hypertensive medication, and/or a clinic blood pressure in the hypertensive range. Receipt of PTSD treatment was defined by CPT code, as at least 8 individual psychotherapy sessions of > 50min during any consecutive 6 months, and/or by SSRI prescription in the medication list. PTSD status, PTSD treatment, and hypertension status were treated as binary, time-dependent variables, as were depression and substance use disorder. Other predictors included gender, race/ethnicity, age, BMI, and smoking.

Results:
In Cox proportional hazard models, PTSD significantly increased risk for incident hypertension (HR = 1.21, 95% CI 1.14 to 1.27); this risk was greatly attenuated among those who received PTSD treatment, and no longer statistically significant (HR = 1.03, 95% CI 0.97 to 1.08). The findings were comparable for each definition of incident hypertension. These findings held for both males and females.

Implications:
In these analyses using administrative data, PTSD prospectively increased risk for incident hypertension, an important chronic disease and early risk factor for CHD. Indication of PTSD treatment was associated with a significant decrease in this risk. Controlled studies are needed to confirm these findings.

Impacts:
These findings indicate that PTSD treatment may be sufficient to mitigate the CVD risk associated with PTSD.