history of exposure. Twenty-five of the studies included veterans whose original traumatic stress was combat-related; the time between the traumatic event and the measurement of cardiovascular activity ranged from 2 months to 29 years. In total, cardiovascular measures of 2670 subjects were analyzed in all the studies. The main finding was that people with a current PTSD diagnosis had a resting heart rate that was 5 beats/minute faster than subjects in the control groups. It has also been observed that an increase in heart rate immediately after a trauma is a predictor of PTSD (Shalev et al. 1998).

Hypertension

Findings that people with PTSD have an increased heart rate are fairly consistent, but results related to blood pressure have been less clear. Some of the epidemiologic studies described above that relied mostly on self-reports for the identification of hypertension also compared its prevalence in veterans with and without PTSD. However, one study that used a more thorough method to assess the prevalence of hypertension in veteran populations with possible PTSD found no increase in hypertension in aging veterans with PTSD. The VA Normative Aging Study was established in 1961 to follow 2280 community-dwelling men in the greater Boston area; more than 90% of the men were veterans at entry in the study. The cohort included 1002 veterans who completed a mailed Mississippi Scale for Combat-Related PTSD in 1990 and 944 veterans who completed the Keane PTSD scale of the Minnesota Multiphasic Personality Inventory in 1986 (Kubzansky et al. 2007). Men with pre-existing angina pectoris, a history of MI, or diabetes were excluded from the study; the mean age of the 1990 study population was 63 years. Study participants receive physical examinations every 3-5 years. A correlation analysis of scores from the Mississippi Scale for Combat-Related PTSD with systolic blood pressure showed no relationship; however, there was a slight correlation (r = −0.06, p = 0.04) between lower diastolic blood pressure and the score on the Mississippi Scale for Combat-Related PTSD but not on the Minnesota Multiphasic Personality Inventory-2. Veterans with higher PTSD scores were at slightly greater risk for total CHD (RR 1.21, 95% CI 0.93-1.57, adjusted for age, smoking, blood pressures, serum total cholesterol, BMI, family history of CHD, education, and alcohol intake), particularly nonfatal MI (RR 1.30, 95% CI 0.92-1.84, adjusted for coronary risk factors). The associations were slightly strengthened when depression was also controlled for. Several of the studies of deployed veterans described above observed a marked increase of PTSD as a result of deployment without any increase in the prevalence of hypertension (Kelsall et al. 2004a; Kubzansky et al. 2007; McCauley et al. 2002b; Schnurr et al. 2000; Spiro et al. 2006).

A study of 147 Dutch resistance fighters in World War II (82 of whom had PTSD) found that the prevalence of hypertension in those with PTSD was not higher than in those without PTSD (32% vs 31%) (Falger et al. 1992). The authors noted that 56% of the veterans, 60-65 years old at the time of the study, were currently suffering from PTSD diagnosed with the SCID according to DSM-III-R criteria. This study is limited by the lack of confirmation by physical examination of the cardiovascular factors reported by participants. A study of Croatian veterans of the Balkan wars (Karlovic et al. 2004) included 43 with PTSD, 37 with PTSD and comorbid MDD, 38 with MDD alone, and 39 healthy controls. Veterans with PTSD (with or without MDD) showed no differences from the other veterans in blood pressure.

One nationally representative study that reported an association between PTSD and hypertension in a civilian population is the NCS (Lauterbach et al. 2005). It compared 429 subjects with PTSD with 5448 subjects without PTSD. Hypertension was reported twice as



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