ArticlePsychological medicine2020
Not all posttraumatic stress disorder symptoms are equal: fear, dysphoria, and risk of developing hypertension in trauma-exposed women.
Article in Psychological medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers.
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Who cites it
15 citing papers in PubMed, 24 citations in OpenAlex.
- Stress, sex, and symptomics: Individual posttraumatic stress symptoms and sexual behaviors in adolescents.Journal of child & adolescent trauma · 2026Article
- Hormonal Contraceptive Use, Stress Disorders, and Cardiovascular and Thrombotic Risk in Women.JAMA network open · 2026Article
- Exploring cardiac-related PTSD symptoms in patients with implantable cardioverter defibrillators: protocol for an open-label trial of written exposure therapy and qualitative study.European journal of psychotraumatology · 2025Article
- Preliminary Results from an RCT Examining the Effects of a Health Behavior Intervention as an Adjunct to Standard Trauma Therapy Among Adults with PTSD.Brain sciences · 2025Article
- Posttraumatic stress disorder and hypertension in older adult Vietnam Era male and female veterans.Journal of traumatic stress · 2025Article
- A randomized, 12-month, parallel-group trial testing the effects of a cognitive behavioral healthy lifestyle intervention as an adjunct to standard trauma therapy among adults with PTSD: the I-CHAT study protocol.Frontiers in psychology · 2025Article
- The impact of PTSD on associations between sex hormones and cardiovascular disease symptoms.European journal of psychotraumatology · 2024Article
- Pilot Findings Indicate a Cognitive Behavioral Healthy Lifestyle Intervention for PTSD Improves Sleep and Physical Activity.Brain sciences · 2023Article
- Dog ownership may promote cardiometabolic health in U.S. military veterans.Scientific reports · 2023Article
- Psychological and biological mechanisms linking trauma with cardiovascular disease risk.Translational psychiatry · 2023Review
- Trauma, psychological distress and markers of systemic inflammation among US women: A longitudinal study.Psychoneuroendocrinology · 2022Article
- PTSD symptom clusters and cardiovascular responses to stress: Reactivity and recovery.Journal of psychosomatic research · 2022Observational
- Involvement of the brain-heart axis in the link between PTSD and cardiovascular disease.Depression and anxiety · 2022Review
- Examining Individual and Synergistic Contributions of PTSD and Genetics to Blood Pressure: A Trans-Ethnic Meta-Analysis.Frontiers in neuroscience · 2021Article
- Ventromedial Hypothalamus Activation Aggravates Hypertension Myocardial Remodeling Through the Sympathetic Nervous System.Frontiers in cardiovascular medicine · 2021Article
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Authors and funding
6 authors at 4 institutions in 1 country.
Funding
Abstract
backgroundPosttraumatic stress disorder (PTSD) is associated with higher risk of incident hypertension, but it is unclear whether specific aspects of PTSD are particularly cardiotoxic. PTSD is a heterogeneous disorder, comprising dimensions of fear and dysphoria. Because elevated fear after trauma may promote autonomic nervous system dysregulation, we hypothesized fear would predict hypertension onset, and associations with hypertension would be stronger with fear than dysphoria.
methodsWe examined fear and dysphoria symptom dimensions in relation to incident hypertension over 24 years in 2709 trauma-exposed women in the Nurses' Health Study II. Posttraumatic fear and dysphoria symptom scores were derived from a PTSD diagnostic interview. We used proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for each symptom dimension (quintiles) with new-onset hypertension events (N = 925), using separate models. We also considered lower-order symptom dimensions of fear and dysphoria.
resultsHigher levels of fear (P-trend = 0.02), but not dysphoria (P-trend = 0.22), symptoms were significantly associated with increased hypertension risk after adjusting for socio-demographics and family history of hypertension. Women in the highest v. lowest fear quintile had a 26% higher rate of developing hypertension [HR = 1.26 (95% CI 1.02-1.57)]; the increased incidence associated with greater fear was similar when further adjusted for biomedical and health behavior covariates (P-trend = 0.04) and dysphoria symptoms (P-trend = 0.04). Lower-order symptom dimension analyses provided preliminary evidence that the re-experiencing and avoidance components of fear were particularly associated with hypertension.
conclusionsFear symptoms associated with PTSD may be a critical driver of elevated cardiovascular risk in trauma-exposed individuals.
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