Do you need a nexus letter for hypertension secondary to an already service connected PTSD or another mental health disorder? Dr. Finnerty can help by reviewing your medical records and reviewing the scientific evidence.
Sample nexus letter statements/ research Dr. Finnerty may use for hypertension/ high blood pressure secondary to PTSD:
There is a significant relationship between PTSD, sleep apnea and hypertension. The medical evidence and research literature supports that it’s at least likely as not (a 50 percent chance or greater) that the Veteran’s hypertension is both due to and substantially aggravated by the psychiatric difficulties from his military service. The supporting medical literature includes:
[see Howard JT, Sosnov JA, Janak JC, Gundlapalli AV, Pettey WB, Walker LE, Stewart IJ, Associations of initial injury severity and posttraumatic stress disorder diagnoses with long-term hypertension risk after combat injury. Hypertension. 2018; 71:824–832] Howard et. al. propose a model for explaining how traumatic events may generate the development of hypertension or other cardiovascular complications. Along the same lines, Alexandre Persu, Géraldine Petit, Coralie Georges, and Philippe de Timary (2018) [see Hypertension, a Posttraumatic Stress Disorder? Time to Widen Our Perspective. Hypertension. 2018; 71: 811–812] emphasize the concept that inflammatory/metabolic, mental health and behavioral pathways underlying the relation between exposure to a physical (or psychological) injury and subsequent development of hypertension (and possibly hypertension resistance) are probably deeply intertwined. They note that in particular, it has been firmly established that both stress and body immune and inflammation-related mechanisms play a crucial role in the pathophysiology of many psychiatric disorders, such as major depression, bipolar disorder, schizophrenia, and autism. Interestingly, exposure to major trauma, such as personal maltreatment or violence, has been found to increase the risk for mental health disorders, and as suggested by Howard et al, this link is mediated by an activation of the immune system. Finally, an additional physiological dimension would be a stimulation of the sympathetic and renin–angiotensin systems, which may also participate in the development of hypertension, in parallel to the stress and inflammatory systems, and may orient the choice of antihypertensive treatments. They note a significant correlation between the chronicity of PTSD (present in a huge proportion of 42% of subjects) and subsequent development of high blood pressure. Matthew M. Burg, PhD, Cynthia Brandt, MD, Eugenia Buta, PhD, Joseph Schwartz, ScD, Harini Bathulapalli, MPH, James Dziura, PhD, Donald E. Edmondson, PhD, and Sally Haskell, MD (2017) [see Risk for Incident Hypertension Associated with PTSD in Military Veterans, and The Effect of PTSD Treatment. Psychosom Med. 2017 Feb-Mar; 79(2): 181–188] note that PTSD increases cardiovascular disease and cardiovascular mortality risk. “In the current study, we observed an overall hypertension incidence over a median 2.4-year follow-up that ranged from 10% to 45%, depending on how hypertension was defined, all in a young sample (average age of 27.9 years, IQR of 24.4–37.6 years). This incidence in a young group of individuals, observed soon after separation from military service is alarming, occurring much earlier than typically observed in the general US population or western societies…” “We observed a 24%–46% greater risk for incident hypertension associated with untreated PTSD in a large, nationally representative sample of almost 200,000 Veterans of OIF/OEF/OND military conflicts.”
Additional research to consider:
- Sexual Violence and Risk of Hypertension in Women in the Nurses’ Health Study II: A 7‐Year Prospective Analysis
Would you like to get a nexus letter for hypertension secondary to PTSD or another mental health condition?
Feel free to reach out to Dr. Finnerty by filling out the form at this link: Free Consultation – Nexus Letters from a Psychologist