PTSD and Hypertension: What’s the Connection?

At any given time, an estimated 7 to 8 percent of Americans have post-traumatic stress disorder (PTSD), a condition of persistent mental and emotional distress resulting from an injury or severe psychological shock. It typically involves flashbacks of the traumatic event and sleep disturbances. (1)

PTSD can often be accompanied by a number of co-occurring health conditions, including depression, anxiety, and substance abuse. A growing body of research shows PTSD may also be linked to high blood pressure.

In fact, a recent study of veterans published in March 2018 in the journal Hypertension found that experiencing a severe injury during war and then receiving a post-traumatic stress disorder diagnosis at a later point doubled the risk of high blood pressure, also called hypertension.

For the study, researchers analyzed data on 3,846 U.S. soldiers wounded from 2002 to 2011 in the wars with Iraq and Afghanistan. (2)

While PTSD can occur in anyone who has experienced a traumatic event, soldiers of war are disproportionately affected. For example, about 7 or 8 out of every 100 people will have PTSD at some point in their lives. According to the U.S. Department of Veterans Affairs, about 11 to 20 out of every 100 veterans who served in Operations Iraqi Freedom and Enduring Freedom experience PTSD in a given year. For veterans of the Gulf War and Vietnam War those numbers are 12 and 15 out of every 100, respectively. (1)

One of the study’s authors, Maj. Ian J. Stewart, MD, a researcher at the David Grant Medical Center at California’s Travis Air Force Base, saw firsthand the types of injuries soldiers suffer and the level of care they receive when he was deployed to Afghanistan.

“The thing that struck me the most was the fantastic care they receive. They truly get the best healthcare in the history of warfare,” he says. “However, once they leave, we don’t really know what happens to them in the long term, and that really has been the impetus for my work.”

Specifically, Dr. Stewart and his team found that soldiers who had 1 to 15 doctor visits for PTSD had nearly double the risk of developing hypertension over a four-year follow-up than vets who had never been diagnosed with PTSD. Those who had more than 15 visits had more than double the risk of developing the condition.

This is concerning, Stewart says, since high blood pressure can lead to a number of health problems.

“Hypertension is often called the silent killer. Unless your blood pressure is really, really high, you’re not really going to have symptoms. The large majority of patients with high blood pressure do not experience any symptoms at all, so it’s easy to put it down the priority list when you’re trying to manage your health. However, the preponderance of evidence is that higher blood pressure greatly increases your risk for a variety of poor outcomes, including heart attacks, strokes, and premature death.”

The researchers estimate that 23,000 U.S. soldiers who fought in Iraq and Afghanistan have been hospitalized with injuries and as many as 9,800 of them could already have PTSD. About 3,200 could also have high blood pressure. According to the study, the cost to treat these veterans with PTSD and hypertension could total up to $42.4 billion a year. (2)

Another study, published in 2017 in The International Journal of Psychiatry in Medicine looked at 100 veterans of wars in Iraq and Iran, half of whom had been diagnosed with PTSD and half of whom had not. The results also showed that those who had a PTSD diagnosis had increased measures of blood pressure compared with their peers who had never had PTSD. (3)

Researchers aren’t sure what might be the underlying reason for the relationship between PTSD and high blood pressure, but Stewart has a theory.

“When you’re initially injured, there’s a huge inflammatory response. Your body responds to an injury very briskly. Our hypothesis is that takes a long time to get completely back to normal.”

PTSD may play a similar role, Stewart explains.

“There’s some evidence that suggests that patients with post-traumatic stress disorder have higher levels of inflammatory markers than control patients without PTSD,” he says. “So one unifying hypothesis is that both of those things are acting together on the immune system and increase subsequent risk of hypertension.”

Stewart says he hopes his study and others like it will lead to increased blood pressure screenings for not only active soldiers who are at risk but also for those who are no longer active and receive care from Veterans Affairs hospitals.

“This is not a short-term thing,” he says. “These patients are going to be suffering the consequences of their injuries for the rest of their lives.”

Additionally, considering the link between mental health and physical health, he says a more holistic approach to treatment is in order.

“We can’t just look at numbers on a blood pressure machine,” Stewart says. “It’s going to take both good mental health and the more classic medical healthcare to optimally take care of these patients.”