Anxiety and mood (대한불안의학회지)

Korean Academy of Anxiety Disorders (대한불안의학회)
권호 표지

Association between Symptoms of Posttraumatic Stress Disorder and Blood Pressure in the Elderly

노인에서 외상 후 스트레스 장애의 증상과 혈압의 연관성

  • Bang, Yu Jin (Department of Neuropsychiatry, Veterans Health Service Medical Center) ;
  • Kang, Suk Hoon (Department of Neuropsychiatry, Veterans Health Service Medical Center) ;
  • Kim, Tae Yong (Department of Neuropsychiatry, Veterans Health Service Medical Center) ;
  • Choi, Jin Hee (Department of Neuropsychiatry, Veterans Health Service Medical Center) ;
  • Chung, Hae Gyung (Department of Neuropsychiatry, Veterans Health Service Medical Center) ;
  • So, Hyung Seok (Department of Neuropsychiatry, Veterans Health Service Medical Center) ;
  • Go, Chang Min (Department of Neuropsychiatry, Veterans Health Service Medical Center)
  • 방유진 (중앙보훈병원 정신건강의학과) ;
  • 강석훈 (중앙보훈병원 정신건강의학과) ;
  • 김태용 (중앙보훈병원 정신건강의학과) ;
  • 최진희 (중앙보훈병원 정신건강의학과) ;
  • 정혜경 (중앙보훈병원 정신건강의학과) ;
  • 소형석 (중앙보훈병원 정신건강의학과) ;
  • 고창민 (중앙보훈병원 정신건강의학과)
  • Received : 2013.09.02
  • Accepted : 2013.09.20
  • Published : 2013.10.31
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Abstract

Objective : Several studies have reported the association between posttraumatic stress disorder (PTSD) and hypertension (HTN). The aim of this study was to evaluate the impact of PTSD symptoms on blood pressure. Methods : Korean veterans of the Vietnam War with (n=62) or without PTSD (n=87) participated in this study. The clinician administered PTSD scale (CAPS) and alcohol use disorder identification test (AUDIT) were applied. Blood pressure, pulse rate, risk factors of HTN and demographic data of the subjects were collected. Effects of potential explanatory variables on HTN were analyzed with logistic regression. Results : Diastolic blood pressure was significantly higher in PTSD group (p=0.015). However, PTSD subjects showed significantly lower pulse rate than non-PTSD subjects (p=0.004). Logistic regression analysis showed that avoidance symptom might be a predictor for hypertension (OR=1.065, p=0.030). Conclusion : These results suggest that PTSD, especially avoidance symptom, might be a risk factor on HTN in the elderly with PTSD. Further studies are needed to evaluate the change of blood pressure according to the clinical improvement of PTSD.

Keywords

References

  1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association;2000.
  2. Heim C, Newport DJ, Mletzko T, Miller AH, Nemeroff CB. The link between childhood trauma and depression: insights from HPA axis studies in humans. Psychoneuroendocrinology 2008;33:693-710. https://doi.org/10.1016/j.psyneuen.2008.03.008
  3. Schneiderman N, Ironson G, Siegel SD. Stress and health: psychological, behavioral, and biological determinants. Annu Rev Clin Psychol 2005;1:607-628. https://doi.org/10.1146/annurev.clinpsy.1.102803.144141
  4. Boscarino JA. Posttraumatic stress disorder and mortality among U.S. Army veterans 30 years after military service. Ann Epidemiol 2006;16:248-256. https://doi.org/10.1016/j.annepidem.2005.03.009
  5. Buckley TC, Kaloupek DG. A meta-analytic examination of basal cardiovascular activity in posttraumatic stress disorder. Psychosom Med 2001;63:585-594. https://doi.org/10.1097/00006842-200107000-00011
  6. Walczewska J, Rutkowski K, Wizner B, Cwynar M, Grodzicki T. Stiffness of large arteries and cardiovascular risk in patients with post-traumatic stress disorder. Eur Heart J 2011;32:730-736. https://doi.org/10.1093/eurheartj/ehq354
  7. Bedi US, Arora R. Cardiovascular manifestations of posttraumatic stress disorder. J Natl Med Assoc 2007;99:642-649.
  8. Dirkzwager AJ, van der Velden PG, Grievink L, Yzermans CJ. Disaster-related posttraumatic stress disorder and physical health. Psychosom Med 2007;69:435-440. https://doi.org/10.1097/PSY.0b013e318052e20a
  9. Dobbs D, Wilson WP. Observations on persistence of war neurosis. Dis Nerv Syst 1960;21:686-691.
  10. McFarlane AC, Atchison M, Rafalowicz E, Papay P. Physical symptoms in post-traumatic stress disorder. J Psychosom Res 1994;38: 715-726. https://doi.org/10.1016/0022-3999(94)90024-8
  11. Boscarino JA, Chang J. Electrocardiogram abnormalities among men with stress-related psychiatric disorders: implications for coronary heart disease and clinical research. Ann Behav Med 1999;21: 227-234. https://doi.org/10.1007/BF02884839
  12. Kang HK, Bullman TA, Taylor JW. Risk of selected cardiovascular diseases and posttraumatic stress disorder among former World War II prisoners of war. Ann Epidemiol 2006;16:381-386. https://doi.org/10.1016/j.annepidem.2005.03.004
  13. Abouzeid M, Kelsall HL, Forbes AB, Sim MR, Creamer MC. Posttraumatic stress disorder and hypertension in Australian veterans of the 1991 Gulf War. J Psychosom Res 2012;72:33-38. https://doi.org/10.1016/j.jpsychores.2011.08.002
  14. Forneris CA, Butterfield MI, Bosworth HB. Physiological arousal among women veterans with and without posttraumatic stress disorder. Mil Med 2004;169:307-312. https://doi.org/10.7205/MILMED.169.4.307
  15. Chaudieu I, Norton J, Ritchie K, Birmes P, Vaiva G, Ancelin ML. Late-life health consequences of exposure to trauma in a general elderly population: the mediating role of reexperiencing posttraumatic symptoms. J Clin Psychiatry 2011;72:929-935. https://doi.org/10.4088/JCP.10m06230
  16. Khoury NM, Marvar PJ, Gillespie CF, Wingo A, Schwartz A, Bradley B, et al. The renin-angiotensin pathway in posttraumatic stress disorder: angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are associated with fewer traumatic stress symptoms. J Clin Psychiatry 2012;73:849-855. https://doi.org/10.4088/JCP.11m07316
  17. Strawn JR, Geracioti TD Jr. Noradrenergic dysfunction and the psychopharmacology of posttraumatic stress disorder. Depress Anxiety 2008;25:260-271. https://doi.org/10.1002/da.20292
  18. Pupo MC, Jorge MR, Schoedl AF, Bressan RA, Andreoli SB, Mello MF, et al. The accuracy of the Clinician-Administered PTSD Scale (CAPS) to identify PTSD cases in victims of urban violence. Psychiatry Res 2011;185:157-160. https://doi.org/10.1016/j.psychres.2009.11.006
  19. Kim HJ, Kim TY, Choi JH, So HS, Chung MY, Kim DS, et al. The application of the clinician administered posttraumatic stress disorder scale to identify combat related posttraumatic stress disorder. Anxiety and Mood 2012;8:113-119.
  20. Lee BO, Lee CH, Lee PG, Choi MJ, Namkoong K. Development of Korean version of Alcohol Use Disorders Identification Test (AUDIT-K): Its reliability and validity. J Korean Academy of Addiction Psychiatry 2000;4:83-92.
  21. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2013;34:2159-2219. https://doi.org/10.1093/eurheartj/eht151
  22. Paulus EJ, Argo TR, Egge JA. The impact of posttraumatic stress disorder on blood pressure and heart rate in a veteran population. J Trauma Stress 2013;26:169-172. https://doi.org/10.1002/jts.21785
  23. Muraoka MY, Carlson JG, Chemtob CM. Twenty-four-hour ambulatory blood pressure and heart rate monitoring in combat-related posttraumatic stress disorder. J Trauma Stress 1998;11:473-484. https://doi.org/10.1023/A:1024400628342
  24. Gavish B, Ben-Dov IZ, Kark JD, Mekler J, Bursztyn M. The association of a simple blood pressure-independent parameter derived from ambulatory blood pressure variability with short-term mortality. Hypertens Res 2009;32:488-495. https://doi.org/10.1038/hr.2009.39
  25. Ruiz-Rodriguez JC, Ruiz-Sanmartin A, Ribas V, Caballero J, Garcia-Roche A, Riera J, et al. Innovative continuous non-invasive cuffless blood pressure monitoring based on photoplethysmography technology. Intensive Care Med 2013;39:1618-1625. https://doi.org/10.1007/s00134-013-2964-2
  26. Beckham JC, Feldman ME, Barefoot JC, Fairbank JA, Helms MJ, Haney TL, et al. Ambulatory cardiovascular activity in Vietnam combat veterans with and without posttraumatic stress disorder. J Consult Clin Psychol 2000;68:269-276. https://doi.org/10.1037/0022-006X.68.2.269
  27. Bangalore S, Sawhney S, Messerli FH. Relation of beta-blocker-induced heart rate lowering and cardioprotection in hypertension. J Am Coll Cardiol 2008;52:1482-1489. https://doi.org/10.1016/j.jacc.2008.06.048
  28. Kimerling R, Clum GA, Wolfe J. Relationships among trauma exposure, chronic posttraumatic stress disorder symptoms, and self-reported health in women: replication and extension. J Trauma Stress 2000;13:115-128. https://doi.org/10.1023/A:1007729116133
  29. O'Donnell ML, Elliott P, Lau W, Creamer M. PTSD symptom trajectories: from early to chronic response. Behav Res Ther 2007;45: 601-606. https://doi.org/10.1016/j.brat.2006.03.015
  30. Marshall RD, Turner JB, Lewis-Fernandez R, Koenan K, Neria Y, Dohrenwend BP. Symptom patterns associated with chronic PTSD in male veterans: new findings from the National Vietnam Veterans Readjustment Study. J Nerv Ment Dis 2006;194:275-278. https://doi.org/10.1097/01.nmd.0000207363.25750.56
  31. Ljubotina D, Pantic Z, Franciskovic T, Mladic M, Priebe S. Treatment outcomes and perception of social acknowledgment in war veterans: follow-up study. Croat Med J 2007;48:157-166.
  32. Brown CD, Higgins M, Donato KA, Rohde FC, Garrison R, Obarzanek E, et al. Body mass index and the prevalence of hypertension and dyslipidemia. Obes Res 2000;8:605-619. https://doi.org/10.1038/oby.2000.79
  33. Benfante R, Reed D, Frank J. Do coronary heart disease risk factors measured in the elderly have the same predictive roles as in the middle aged. Comparisons of relative and attributable risks. Ann Epidemiol 1992;2:273-282. https://doi.org/10.1016/1047-2797(92)90060-4
  34. O'Brien E, Asmar R, Beilin L, Imai Y, Mancia G, Mengden T, et al. Practice guidelines of the European Society of Hypertension for clinic, ambulatory and self blood pressure measurement. J Hypertens 2005;23:697-701. https://doi.org/10.1097/01.hjh.0000163132.84890.c4