2 The Renin-Angiotensin Pathway in PTSD: the association between ACE inhibitor and ARB medications and traumatic stress symptoms Open Access

Khoury, Nayla Muin (2012)

Permanent URL: https://etd.library.emory.edu/concern/etds/3r074v89v?locale=en
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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

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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

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