Assessment of Hypertension and Military Deployments

Abstract

Introduction: High-stress situations, such as military deployments, may be a risk factor for hypertension. The relationship between the stress triggered by combat deployment and hypertension is unknown. Acute stress from combat conditions can cause a temporary rise in blood pressure, which decreases within hours or days. Cross-sectional studies have shown no association between hypertension and deployment to the 1991 Gulf War or to Vietnam. Self-reported hypertension often is used as an outcome in large population studies. Fair to substantial agreement has been observed between self-reported hypertension and various sources of administrative data, medical records, and blood pressure measurements. The goal of this dissertation was to determine whether recent deployment to Iraq and Afghanistan was associated with new-onset hypertension.Methods: Baseline Millennium Cohort Study questionnaires (July 2001 to June 2003) were completed by 77,047 individuals. Follow-up questionnaires (June 2004 to February 2006) were completed by 55,021 responders. The relationship between new-onset hypertension and history of a recent military deployment was assessed through multivariable logistic regression (N=37,075). Baseline data were analyzed cross-sectionally to assess factors associated with prevalent hypertension (N=70,100). Kappa statistics were used to compare self-reported hypertension with provider diagnosed hypertension and prescription antihypertensive medication dispensed (N=41,129).Results: The 3-year incidence of hypertension was 6.9%. After adjusting for demographic and lifestyle characteristics, deployers without combat exposure were less likely to develop new-onset hypertension compared to nondeployers (odds ratio [OR]=0.74; 95% confidence interval [CI]: 0.64, 0.85). There was no association between deployment with combat exposure and hypertension compared to nondeployers (OR=0.94; 95% CI: 0.82, 1.07). Among deployers reporting combat exposures, the risk for incident hypertension was 1.31 (95% CI: 1.07, 1.61) compared to deployers not reporting combat exposures. The prevalence of self-reported hypertension at baseline among Cohort members was 10.4%. There was moderate agreement between self-reported hypertension and provider-diagnosed hypertension, as well as antihypertensive medications dispensed.Conclusion: Military service members are adversely affected by hypertension. Although deployers had lower incidence of hypertension compared to nondeployers, individuals reporting combat exposures were more likely to report new-onset hypertension. Self-reported hypertension had moderate reliability compared with provider-diagnosed hypertension and dispensed antihypertensive medication.