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J Hypertens. 2020 Jan 27. doi: 10.1097/HJH.0000000000002364. [Epub ahead of print]

Hypertension in military veterans is associated with combat exposure and combat injury.

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Department of Defense Joint Trauma System, Defense Health Agency, Joint Base San Antonio-Fort Sam, Houston.
Department of Kinesiology, Health and Nutrition, University of Texas at San Antonio, San Antonio, Texas.
David Grant USAF Medical Center, Travis Air Force Base, California.
Uniformed Services University of Health Sciences, Bethesda, Maryland.
Deployment Health Research Department, Naval Health Research Center, San Diego, California.
375th Medical Group, Scott Air Force Base, Illinois.
Department of Kinesiology, College of Education, Health, and Human Services, California State University, San Marcos, California, USA.



Although the long-term effects of combat injury are not well understood, there is emerging concern that exposure to combat environments and subsequent injury may increase the risk of hypertension through changes in inflammatory responses, psychological stress and mental health, and health behaviors.


Data from the Millennium Cohort Study and the Department of Defense Trauma Registry were used to identify combat-exposed and combat-injured participants. Incident hypertension diagnoses were ascertained from the Millennium Cohort survey. The associations between combat exposure/injury and hypertension risk was estimated using multivariable complementary log-log survival models.


The final analysis sample consisted of 38 734 participants. Of these, 50.8% deployed but were not exposed to combat, 48.6% deployed and were exposed to combat, and 0.6% had combat injury. Overall prevalence of hypertension was 7.6%. Compared with participants who deployed but did not experience combat (mild exposure), elevated odds of hypertension were observed among those who experienced combat but not wounded (moderate exposure; AOR, 1.28; 95% CI, 1.19-1.38) and those wounded in combat (high exposure; AOR, 1.46; 95% CI, 1.07-2.00). Sleep duration of less than 4 h (AOR, 1.21; 95% CI, 1.03-1.43), sleep duration of 4-6 h (AOR, 1.16; 95% CI, 1.05-1.29), posttraumatic stress disorder (AOR, 1.54; 95% CI, 1.26-1.87), and overweight (AOR, 1.77; 95% CI, 1.61-1.95) and obese (AOR, 2.77; 95% CI, 2.45-3.12) status were also associated with higher odds of hypertension.


Results support the hypotheses that combat exposure increases hypertension risk and that combat injury exacerbates this risk.

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