HYPERTENSION AND POST-TRAUMATIC STRESS DISORDER: A STRONG ASSOCIATION IN AN AFRICAN POPULATION EXPOSED TO FREQUENT VIOLENCE

Abstract

Abstract Objective: Our interdisciplinary team has recently documented a high prevalence of Post-Traumatic Stress Disorders (PTSD) in patients with treatment-resistant hypertension, altogether with emotion regulation deficits and a psychopathological expression. The objective of the current study was to look for the prevalence and nature of psychological abnormalities and PTSD in hypertensive patients from Bukavu, a city located in South-Kivu (Democratic Republic of Congo) and at war for the last 20 years. Design and method: We compared the levels of trauma exposure, psychiatric disorders including PTSD, emotion regulation strategies and social support of hypertensive patients vs. normotensive controls enrolled at the Internal Medicine Department of Bukavu General Hospital. Results: We compared 47 patients with hypertension (62% women, age: 41 ± 13 years, BMI: 24.5 ± 3.5 kg/m2, BP: 139 ± 12/83 ± 7 mmHg on a median of 1.7 antihypertensive drugs) with 55 normotensive subjects (73% women, age: 43 ± 14 years, BMI: 22.4 ± 3.5 kg/m2, BP: 122 ± 10/76 ± 8 mmHg) without cardiovascular or renal disease. Compared with normotensive controls, hypertensive patients had been exposed to more severe traumas (p < 0.001), more frequently due to physical aggression (p < 0.001), developed more frequent PTSDs (68% vs. 4%, p < 0.001), Major Depressive Disorders (60% vs. 27%, p = 0.001), and Alcohol Use Disorders (49% vs. 2%, p = 0.006). Hypertensive patients also presented with less adaptive emotion regulation strategies (more tendencies for anger in (p = 0.01), emotional suppression (p = 0.043), self-blame (p = 0.04), rumination (p = 0.012) and catastrophizing (p = 0.029) contrasting with less tendencies for acceptance (p = 0.017) and emotional reappraisal (p = 0.024)). Finally, hypertensive patients received less social support from companion, friends and the community (p < 0.05). Conclusions: Altogether, this study shows a striking association between trauma exposure, various psychopathological disorders, in particular PTSD and hypertension. Psychological and traumatic factors may be an important but underestimated contributor to the increasing prevalence of hypertension in Subsaharan African populations.