Military Sexual Trauma Is Associated With Incident Hypertension In A 16-year Cohort Study Of 1.2 Million Young And Middle-aged Men And Women

Introduction: Exposure to traumatic events and the sequelae [e.g., posttraumatic stress disorder (PTSD) and poor health] are linked to incident cardiovascular disease (CVD) in military and community samples. Veterans, especially women, are 3-times as likely to experience sexual harassment and assault [military sexual trauma (MST)] compared to civilian populations. It is unknown if exposure to MST is independently associated with risk of incident hypertension. Methods: We conducted a retrospective analysis to assess the effect of MST on the risk of incident hypertension, defined as a medical record diagnosis, meeting clinical threshold based on blood pressure in vital sign records, or use of antihypertensive medication, in a cohort of 1,177,944 young and middle-aged veterans (mean age= 30.2 [SD:9.2], 12% women) using nationwide data from the Veterans Health Administration from 2001 to 2017. Time-varying multivariate Cox models were computed to estimate hypertension risk by MST status while sequentially adjusting for demographics, lifestyle factors, CVD comorbidities, and psychiatric disorders. Sensitivity analyses controlled for healthcare utilization based on the number of primary care visits over two years after military discharge. Results: During 16 years of follow-up (mean=9.6 years [SD:4.0]), 33,881 veterans screened positive for MST (65% women) and 307,332 patients were diagnosed with hypertension. The overall incidence rate of hypertension was 305.1 events per 1,000-person years. MST was associated with a 30% greater risk of hypertension in unadjusted models (hazard ratio [HR], 1.30 [95% CI, 1.28-1.33]) and remained significantly associated with hypertension in models that adjusted for demographics, lifestyle factors, CVD comorbidities, PTSD, anxiety, and depression (adjusted HR, 1.10 [95% CI, 1.08-1.12]. In sensitivity analyses, the effect of MST remained significant when controlling for healthcare utilization (HR, 1.11, [95% CI, 1.09-1.13]). Conclusions: In this large prospective cohort of young adults, MST was associated with an increased risk of hypertension after controlling for established risk factors. Further research is needed to determine if early identification of MST improves cardiovascular risk management.