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Use of renin-angiotensin system blockers and posttraumatic stress disorder risk in the UK Biobank: a retrospective cohort study

Authors
 Sunghyuk Kang  ;  Jimin Kim  ;  Ji Su Yang  ;  Ye Jin Jeon  ;  Hyeok-Hee Lee  ;  Shakira F Suglia  ;  Alexander C Tsai  ;  Jee In Kang  ;  Sun Jae Jung 
Citation
 BMC MEDICINE, Vol.22(1) : 489, 2024-10 
Journal Title
BMC MEDICINE
Issue Date
2024-10
MeSH
Adult ; Aged ; Angiotensin Receptor Antagonists* / adverse effects ; Angiotensin Receptor Antagonists* / therapeutic use ; Angiotensin-Converting Enzyme Inhibitors* / adverse effects ; Angiotensin-Converting Enzyme Inhibitors* / therapeutic use ; Antihypertensive Agents / therapeutic use ; Biological Specimen Banks ; Female ; Humans ; Longitudinal Studies ; Male ; Middle Aged ; Renin-Angiotensin System* / drug effects ; Retrospective Studies ; Stress Disorders, Post-Traumatic* / drug therapy ; Stress Disorders, Post-Traumatic* / epidemiology ; UK Biobank ; United Kingdom / epidemiology
Abstract
Background: Previous research has shown that the use of renin-angiotensin system (RAS) blockers is linked to a lower prevalence of posttraumatic stress disorder (PTSD), but longitudinal studies are scarce. We aimed to estimate the association between the use of RAS blockers and the risk of PTSD among individuals taking antihypertensive medications.

Methods: This longitudinal study included participants aged 40-69 from the UK Biobank. Exposure data were obtained from the initial assessment (2006-10), while outcome data were obtained from the online mental health questionnaire administered 6-11 years later (2016-17). We included participants who were under antihypertensive treatment and did not have a prior diagnosis of PTSD before the initial assessment. Use of RAS blockers was defined as self-reported regular use, at the initial assessment, of angiotensin-converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB). Among participants who experienced adverse life experiences, cases of probable PTSD were defined with the six-item PTSD Checklist-Civilian version score ≥ 14. Logistic regression with inverse probability of treatment weighting was used to estimate the odds ratios (ORs) and 95% confidence interval (CI) for the association between RAS blocker use and the risk of probable PTSD.

Results: Of the 15,954 participants (mean age = 59.9 years; 42.6% women) under antihypertensive treatment with no prior history of PTSD at the initial assessment, 64.5% were taking RAS blockers. After a mean follow-up of 7.5 years, 1,249 (7.8%) were newly identified with probable PTSD. RAS blocker users had a lower risk of probable PTSD than RAS blocker non-users (OR = 0.84 [95% CI: 0.75-0.94]), whereas the use of other antihypertensive medications showed no such association (users vs. non-users; calcium channel blockers, OR = 0.99 [95% CI: 0.88-1.11]; beta-blockers, 1.20 [1.08-1.34]; and thiazide-related diuretics, 1.15 [1.03-1.29]). The association between probable PTSD risk and the use of ACEi vs. ARB showed no significant difference (p = 0.96).

Conclusions: Among individuals under antihypertensive treatment, the use of RAS blockers was associated with a decreased risk of probable PTSD. This added benefit of RAS blockers should be considered in the selection of antihypertensive medications.
Files in This Item:
T202407076.pdf Download
DOI
10.1186/s12916-024-03704-5
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Preventive Medicine (예방의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Psychiatry (정신과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Jee In(강지인) ORCID logo https://orcid.org/0000-0002-2818-7183
Jung, Sun Jae(정선재) ORCID logo https://orcid.org/0000-0002-5194-7339
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/201383
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