Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA.
J Clin Psychiatry. 2012 Jun;73(6):849-55. doi: 10.4088/JCP.11m07316. Epub 2012 May 1.
Posttraumatic stress disorder (PTSD) is a debilitating stress-related illness associated with trauma exposure. The peripheral and central mechanisms mediating stress response in PTSD are incompletely understood. Recent data suggest that the renin-angiotensin pathway, essential to cardiovascular regulation, is also involved in mediating stress and anxiety. In this study, the authors examined the relationship between active treatment with blood pressure medication, including angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), and PTSD symptom severity within a highly traumatized civilian medical population.
Cross-sectional, observational data were analyzed from a larger study; patients were recruited from Grady Memorial Hospital's outpatient population from 2006 to November 2010. Multivariable linear regression models were fit to statistically evaluate the independent association of being prescribed an ACE inhibitor or ARB with PTSD symptoms, using a subset of patients for whom medical information was available (n = 505). Categorical PTSD diagnosis was assessed using the modified PTSD Symptom Scale (PSS) based on DSM-IV criteria, and PTSD symptom severity (the primary outcome of interest) was measured using the PSS and Clinician Administered PTSD Scale.
A significant association was determined between presence of an ACE inhibitor/ARB medication and decreased PTSD symptoms (mean PSS score 11.4 vs 14.9 for individuals prescribed vs not prescribed ACE inhibitors/ARBs, respectively [P = .014]). After adjustment for covariates, ACE inhibitor/ARB treatment remained significantly associated with decreased PTSD symptoms (P = .044). Notably, other blood pressure medications, including β-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 diagnosed with PTSD. Further studies should examine whether available medications targeting this pathway should be considered for future treatment and potential protection against PTSD symptoms.
创伤后应激障碍（PTSD）是一种与创伤暴露相关的使人虚弱的应激相关疾病。介导 PTSD 应激反应的外周和中枢机制尚未完全阐明。最近的数据表明，肾素-血管紧张素途径对于心血管调节至关重要，也参与介导应激和焦虑。在这项研究中，作者研究了在高度创伤的平民医疗人群中，积极使用包括血管紧张素转换酶（ACE）抑制剂和血管紧张素受体阻滞剂（ARB）在内的降压药物治疗与 PTSD 症状严重程度之间的关系。
从一项更大的研究中分析了横断面、观察性数据；2006 年至 2010 年 11 月期间，从 Grady Memorial 医院的门诊人群中招募患者。使用有医疗信息的患者子集（n=505），拟合多变量线性回归模型，以从统计学上评估被处方 ACE 抑制剂或 ARB 与 PTSD 症状的独立关联。使用基于 DSM-IV 标准的改良 PTSD 症状量表（PSS）评估 PTSD 诊断，使用 PSS 和临床医生管理 PTSD 量表测量 PTSD 症状严重程度（主要关注的结果）。
确定 ACE 抑制剂/ARB 药物的存在与 PTSD 症状减少之间存在显著关联（分别为被处方 ACE 抑制剂/ARB 的个体和未被处方 ACE 抑制剂/ARB 的个体的平均 PSS 评分 11.4 与 14.9[P=0.014]）。在调整协变量后，ACE 抑制剂/ARB 治疗仍与 PTSD 症状减少显著相关（P=0.044）。值得注意的是，其他降压药物，包括β受体阻滞剂、钙通道阻滞剂和利尿剂，与 PTSD 症状减轻没有显著关联。
这些数据提供了第一个临床证据，支持肾素-血管紧张素系统在 PTSD 患者应激反应调节中的作用。进一步的研究应该研究针对该途径的现有药物是否应考虑用于未来的治疗和预防 PTSD 症状。
