Sex Differences in Antihypertensive Medications and PTSD Incidence

Evidence suggests there may be a protective association between some antihypertensive medications and posttraumatic stress disorder (PTSD) incidence, but few samples are large enough to examine sex differences in these associations.

Data came from a trauma cohort established from the Danish national registries from 1994 to 2016. All cohort members experienced at least one of the seven potentially traumatic events (PTE). Those exposed redeemed prescriptions for antihypertensive medications (beta blockers, angiotensin II receptor blockers [ARBs], angiotensin-converting enzyme inhibitors [ACE-Is], and calcium channel blockers) within 60 days prior to PTE. For the unexposed group, three persons who never redeemed an antihypertensive medication prescription were matched to each exposed person on age, sex, and time of trauma. The outcome was incident PTSD over 22 years of follow-up (average follow-up time was 5-6 years). We conducted descriptive analyses followed by Cox proportional hazards regression adjusted for marital status, income, trauma group, Charlson Comorbidity Index score before the PTE, and comedication use of statins, non-steroidal anti-inflammatory drugs, and antidepressants to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Analyses were sex-stratified.

We observed evidence of a protective association between calcium channel blockers and the development of PTSD for females (HR = 0.79; 95% CI = 0.29, 2.2) and males (HR = 0.49; 95% CI = 0.22, 1.1). For females, the adjusted association between ARBs and PTSD was 0.47 (95% CI = 0.11, 2.1); for males, the adjusted association was 1.4 (95% CI = 0.50, 3.6). A slight protective effect was also observed for beta-blockers among males, while these associations closer to the null were observed for females. For both sexes, associations with ACEs were closer to the null.

These results suggest possible sex differences in the potentially protective effects of antihypertensive medications on the development of PTSD, although imprecision in measurement indicates results should be interpreted with caution.