2 The Renin-Angiotensin Pathway in PTSD: the association between ACE inhibitor and ARB medications and traumatic stress symptoms Öffentlichkeit
Khoury, Nayla Muin (2012)
Published
Abstract
4
An abstract of
A thesis submitted to the Faculty of the
Rollins School of Public Health of Emory University
In partial fulfillment of the requirements for the degree of
Masters of Public Health
In Epidemiology
2012
5
ABSTRACT
The Renin-Angiotensin Pathway in PTSD: the association between
ACE inhibitor and ARB
medications and traumatic stress symptoms
PTSD is a stress-related illness associated with trauma exposure.
The mechanisms mediating stress response in PTSD are incompletely
understood. Preclinical data suggest that the renin-angiotensin
(RAAS) pathway, essential to cardiovascular regulation, is also
involved in mediating stress and anxiety. Treatment of psychiatric
conditions with RAAS-modifying medications has not been the focus
of clinical trials. In this study, we examined the relationship
between treatment with blood pressure
medication, including angiotensin converting enzyme inhibitors
(ACE-I) and angiotensin receptor blockers (ARBs), and PTSD symptom
severity within a highly traumatized civilian medical
population.
Multi-variable linear regression models were fit to
statistically evaluate the independent association of taking an
ACE-I or ARB with PTSD symptoms, using a sub-set of patients from a
larger study recruiting patients from Grady's outpatient waiting
rooms from 2006 to November 2010 for whom medical information was
available (n=505). PTSD diagnosis was assessed using the modified
PTSD Symptom Scale (PSS) based on DSM-IV criteria with PTSD
symptoms based on PSS and Clinician Administered PTSD Scale
(CAPS).
A significant association was found between presence
of ACE-I / ARB medication and decreased PTSD symptoms (mean PSS
score 11.4 vs 14.9 for individuals prescribed vs not prescribed
ACE-I/ARBs, respectively (p = 0.014)). After adjustment for
covariates, ACE-I/ARB treatment remained significantly associated
with decreased PTSD symptoms (p = 0.044). Other blood pressure
medications, including beta-blockers, calcium channel blockers, and
diuretics, were not significantly associated with reduced PTSD
symptoms.
These data provide the first clinical evidence
supporting a role for the renin-angiotensin system in the
regulation of stress response in patients with PTSD. Further
studies should examine whether available medications targeting this
pathway may be beneficial for future treatment and potential
protection against PTSD symptoms. Efforts to better understand the
disease mechanisms and to improve treatment strategies have
important public health implications to reduce PTSD's impact on
individuals and society.
Table of Contents
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TABLE OF CONTENTS
Chapter I: Background Literature Review
Page 1
Background
Page 1
Methods
Page 2
Results
Page 2
Conclusions
Page 7
Chapter II: Manuscript
Page 10
Abstract
Page 10
Introduction
Page 11
Methods
Page 12
Results
Page 17
Discussion
Page 19
Clinical Points
Page 21
Tables and figures
Page 22
Chapter III: Discussion
Page 27
Summary
Page 27
Public Health Implications and Future Directions
Page 28
References
Page 31
About this Master's Thesis
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