Exposure To Childhood Abuse Is Associated With Hypertension In South African Women

Objective: Childhood abuse (CA), which affected at least half of the children globally, has increasingly been shown to adversely impact physical health in adulthood. We investigated the associations of CA with hypertension in 18–40-year-old South African women in the Kwazulu-Natal Province of South Africa, using the baseline data of the Rape Impact Cohort Evaluation study. Design and method: In this cross-sectional study, CA was defined as sexual, physical and emotional abuse, and/or parental neglect. Hypertension was defined as blood pressure equal or above 140/90 mmHg or known hypertension on treatment. Logistic regression models examining the associations between childhood abuse and hypertension adjusted for traditional hypertension risk factors, rape exposure, HIV-infection, other traumatic exposures, depressive symptom scores and post-traumatic stress disorder (PTSD) scores. The mediating effects of hypertension risk factors on the associations were also explored. Results: Among 1797 women, median age 24 years (25th-75th: 21–29 years), the prevalence of exposure to CA was significantly higher in those with compared to without hypertension: any CA: 70.9% vs 57.2%, sexual abuse: 20.9% vs 12.4%, physical abuse: 51.8% vs 41.5%, emotional abuse: 40% vs 27.6% and parental neglect: 35% vs 25.7%. In the regression analyses, exposures to any CA (adjusted odds ratio: 1.04; 95%CI: 1.01–1.07; p = 0.014), sexual abuse (1.05; 1.01–1.10; p = 0.026) and emotional abuse (1.05; 1.01–1.08; p = 0.009) were associated with hypertension. The associations of physical abuse (1.03; 1.00–1.06; p = 0.074) and parental neglect (1.03; 0.99–1.06; p = 0.132) with hypertension were borderline to non-significant. Increasing frequency of CA and exposure to multiple types of CA were associated with higher odds of hypertension. The observed associations were partially mediated by alcohol consumption, other trauma experienced, depression and PTSD. Conclusions: The associations of CA with hypertension highlight that, while CA must be prevented, effective mental health interventions are needed to prevent hypertension in women exposed to CA.