Military Sexual Trauma Tied to Risk for Hypertension

Megan Brooks

September 30, 2021

Sexual harassment or assault during military service among young and middle-aged veterans is associated with an increased risk for hypertension, a new study suggests.

"Understanding a patient's trauma history is invaluable for treating the whole person," Allison E. Gaffey, PhD, Yale University School of Medicine, New Haven, Connecticut, and the VA Connecticut Healthcare System, told theheart.org | Medscape Cardiology.

"Assessing men and women's history of trauma, including sexual trauma, is critical for recognizing nontraditional factors that contribute to their cardiovascular risk and to gain a more comprehensive understanding of their mental and physical health," Gaffey added.

She presented her research September 29 during the virtual American Heart Association (AHA) Hypertension Scientific Sessions 2021.

Lasting Impact on Physical Health

Gaffey and colleagues analyzed data from the Veterans Health Administration for roughly 1.2 million veterans (mean age, 30.2 years; 12% female) who were discharged from the military after September 30, 2001 and who received healthcare services at VA medical centers from 2001 to 2017. 

All were screened for sexual harassment and assault, known as military sexual trauma (MST), when they first began receiving VA care.

During 16 years of follow-up, 33,881 veterans screened positive for MST (65% women) and 307,332 developed hypertension (15% women).

Overall, MST was associated with a 30% increase in risk for incident hypertension in unadjusted models (hazard ratio [HR], 1.30; 95% CI, 1.28 - 1.33; < .001).

After adjustment for demographic characteristics, lifestyle factors, cardiovascular comorbidities, post-traumatic stress disorder (PTSD), anxiety, and depression, MST remained significantly associated with hypertension (adjusted HR, 1.10; 95% CI, 1.08 - 1.12; < .001).

When women and men were examined separately, the link between MST and risk for hypertension remained for both groups, but was slightly stronger among women.

"Sexual trauma has been associated with autonomic dysfunction, inflammation, and dysregulation in the hypothalamic pituitary adrenal axis and renin-angiotensin-aldosterone system, which could lead to elevations in BP over time," Gaffey told theheart.org | Medscape Cardiology.

"These findings show that even many years after being discharged from military service, exposure to military sexual trauma can continue to significantly influence veterans' physical health," she added.

Gaffey said it will be important to determine if early treatment of MST improves hypertension risk, particularly among those showing elevated blood pressure or stage 1 hypertension.

Social Determinants of Health

Willie Lawrence, Jr., MD, head of the AHA National Hypertension Control Initiative oversight committee, said the findings in this study are "in line with what we know about the impact of social determinants of health on high blood pressure."

"There are studies that suggest that things that we historically don't look at as risk factors for hypertension — lifelong racism, crime, mental health status — do in fact predict your risk of developing hypertension," Lawrence, from Spectrum Health in Benton Harbor, Michigan, told theheart.org | Medscape Cardiology.

"It's not just your genetics that will determine your health, and there are a lot of things that will affect your blood pressure. Your blood pressure is really just a barometer of everything that's going on in your life and some of the things that have gone on in your life in the past," added Lawrence, who wasn't involved in the study.

Funding for the study was provided by the US Department of Veterans Affairs. Gaffey and Lawrence have no relevant disclosures.

Hypertension Scientific Sessions 2021: Presentation 48. Presented September 29, 2021.

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