Military sexual trauma and incident hypertension: a 16-year cohort study of young and middle-aged men and women

Abstract

Objectives: Veterans, especially women, are three times more to experience sexual harassment and assault [military sexual trauma (MST)] than civilians. As trauma is associated with elevated cardiovascular risk, we investigated whether MST independently contributes to risk for incident hypertension and whether the effects are distinct among women. Methods:We assessed 788 161 post-9/11 Veterans (Mage ¼ 32.14 years, 13% women) who were free of hypertension at baseline, using nationwide Veterans Health Administration data collected 2001-2017. Time-varying, multivariate Cox proportional hazard models were used to examine the independent contribution of MST to new cases of hypertension while sequentially adjusting for demographics, lifestyle and cardiovascular risk factors, including baseline blood pressure, and psychiatric disorders including posttraumatic stress disorder. We then tested for effect modification by sex.Results: Over 16 years [mean ¼ 10.23 (SD: 3.69)], 35 284 Veterans screened positive for MST (67% were women). In the fully adjusted model, MST was associated with a 15% greater risk of hypertension [95% confidence interval (95% CI) 1.11-1.19]. In sex-specific analyses, men and women with a history of MST showed a 6% (95% CI, 1.00-1.12, P ¼ 0.042) and 20% greater risk of hypertension (95% CI, 1.15-1.26, P < 0.001), respectively. Conclusion:In this large prospective cohort of young and middle-aged Veterans, MST was associated with incident hypertension after controlling for established risk factors, including trauma-related psychiatric disorders. Although MST is disproportionately experienced by women, and the negative cardiovascular impact of MST is demonstrated for both sexes, the association with hypertension may be greater for women. Subsequent research should determine if early MST assessment and treatment attenuates this risk.

2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension

“…Patients with mental distress may develop a sudden increase in BP, which may normalize when the distress is relieved [456]. Growing evidence also links the exposure to intensely traumatic life events with an increased risk of hypertension [456][457][458][459]. Recent meta-analyses report promising results for the ability of mind-body stress reducing interventions to not only reduce stress and mood swings but also SBP and DBP, although the quality of the evidence is low [366,460].…”

Maternal chronic hypertension in women veterans

“…Potential causes for these observed disparities include the multifaceted effects of systemic racism and a higher burden of psychosocial stressors from racial discrimination and caregiving stress. These can be compounded by other factors associated with hypertension that affect many women Veterans at large, including post‐traumatic stress disorder and military sexual trauma 21–23 . The two factors most strongly associated with receipt of an AHM recommended for use in pregnancy both prior to and during pregnancy were uncontrolled hypertension and Black race.…”

“…These can be compounded by other factors associated with hypertension that affect many women Veterans at large, including post‐traumatic stress disorder and military sexual trauma. 21 , 22 , 23 The two factors most strongly associated with receipt of an AHM recommended for use in pregnancy both prior to and during pregnancy were uncontrolled hypertension and Black race. This could largely be attributed to the inclusion of HCTZ in the recommended AHM category.…”

Blood Pressure Control and Maintenance in a Prospective Cohort of Younger Veterans: Roles of Sex, Race, Ethnicity, and Social Determinants of Health

“…Covariates were chosen a priori and measured at baseline or during the first evidence of diagnosis across follow-up. These included demographics: age (<40 vs ≥40 years) and marital status (married vs not married); behavioral/lifestyle factors: smoking status (current, past, never), body mass index (BMI; categories of underweight/normal, overweight, and obese [reference]), and history of an alcohol or substance use disorder (ever diagnosed vs. never [reference]); history of MST 27 and other clinical risk factors (ever diagnosed vs. never [reference]): posttraumatic stress disorder (PTSD), obstructive sleep apnea (OSA), Type 1 or 2 diabetes, dyslipidemia; and the number of comorbidities using a modified version of the Charlson Comorbidity Index (i.e., this version did not include leukemia or lymphoma in the weights). 28 Lastly, a healthcare utilization variable was created based on the number of primary care visits completed within first 2 years.…”