Long-term follow-up of blood pressure in family members of soldiers killed during the war in Bosnia and Herzegovina

Aim

To asses prevalence of essential arterial hypertension in family members of soldiers killed in 1992-1995 war in Bosnia and Herzegovina.

Methods

The study enrolled 1144 subjects who lost a family member in the war and 582 of their close neighbors who experienced no such loss. Data on their medical history and habits were collected, and their blood pressure was recorded in 1996 and 2003. Arterial hypertension was defined as systolic blood pressure ≥140 mm Hg (≥130 mm Hg in patients with diabetes mellitus), or diastolic blood pressure ≥90 mm Hg (≥80 mm Hg in patients with diabetes mellitus), or taking antihypertensive therapy. Additional laboratory and clinical tests were performed in subjects with hypertension.

Results

The prevalence of hypertension at both time points was higher in the group with a killed family member than in the group without the loss (55.1% vs 42.1%, P<0.001 in 1996, and 50.7% vs 39.0%, P<0.001 in 2003, respectively). However, there was also a significant decrease in the prevalence of hypertension in the group with the loss in 2003 (P<0.001), but not in group without the loss. Posttraumatic stress disorder (PTSD), smoking, and alcohol consumption were more prevalent in the group with a killed family member, but not cholesterol and triglyceride blood concentrations. In both groups, hypertension was more prevalent in subjects with PTSD and smoking or drinking habit. Proportion of subjects with hypertension who smoked and used alcohol was similar in both groups. Proportion of subjects with hypertension who did not smoke or drink was higher in the group with the loss (51.1% vs 36.7%, P<0.001; 46.2% vs 35.0%, P = 0.006; respectively).

Conclusion

This study showed higher prevalence of hypertension in family members of killed soldiers, regardless of the presence of other cardiovascular risk factors. Only the stress of mourning was associated with higher prevalence of hypertension. Over time, proportion of hypertensive subjects with the loss decreased in the group with a killed family member, further suggesting that at least a part of their hypertension might have been of psychological origin.Many studies investigated the effect of stress on various aspects of health status, but few found the association between stress and a particular disease (1-3). At the same time, the belief that stress causes and aggravates arterial hypertension is a widespread opinion among lay public, despite the lack of strong evidence. Arterial hypertension is currently defined as systolic blood pressure ≥140 mm Hg, or diastolic blood pressure ≥90 mm Hg, or taking antihypertensive therapy (4). In patients with diabetes mellitus, it is defined as systolic blood pressure ≥130 mm Hg, or diastolic blood pressure ≥80 mm Hg, or taking antihypertensive therapy (4). The exact etiology of essential arterial hypertension remains an enigma, primarily due to the high number of systems involved in the regulation of arterial pressure (5). Several factors are suggested as contributing to the hypertension – genetic factors, salt sensitivity, changes in ion homeostasis (sodium, potassium, and calcium), changes in renin-angiotensin-aldosteron system, insulin resistance, stimulation of sympathetic nervous system, and deficiency of vasodilator substances (5,6). Also, a number of environmental factors may have a role in the development of high blood pressure, such as salt intake, obesity, occupation, and alcohol intake (5). However, stress itself is not among them (5). This could be the consequence of the fact that it is very hard to design an objective study on the effect of stress on the arterial hypertension, due to substantial difficulties in defining, perception, and measurement of stress (7,8). A large study among employees of Australian government tax office showed no direct effect of job stress on blood pressure, but suggested a significant relationship of increased blood pressure and unhealthy habits, such as smoking, alcohol consumption, physical inactivity, and obesity, especially in men (9).One of the most convincing, although unwanted, models of chronic stress is war. There are many studies on psychiatric health status of the soldiers and war veterans, dealing mainly with the evaluation of posttraumatic stress disorder (PTSD) (10-14), and a considerable number of studies investigating physical health of the soldiers (15-19). At the same time, somatic status of civilians affected by war was evaluated less frequently. A study on Afghan, Iranian, and Somali asylum seekers, and refugees living in the Netherlands showed that they suffered mainly from PTSD, depression, and anxiety (20), whereas the Israeli civilians had significantly higher levels of anxiety, despite the normal levels of cortisol and growth hormone (21). Several studies investigated the effect of the 1991-1995 war in Croatia. A study of prevalence of risk factors for cerebrovascular disease after the war in Croatia found significantly higher rate of arterial hypertension, hyperlipidemia, and obesity in people suffering from PTSD (22). A retrospective study on the prevalence of acute coronary syndrome before and during the 1992-1995 war in Bosnia and Herzegovina revealed increased number of acute myocardial infarctions and unstable angina pectoris cases during the war (23).All of these studies evaluated the effects of general war stress on health, but none of them investigated the effect of the family member loss during the war, which is a frequent situation during military operations, and at the same time, an experience considered to cause great immediate stress reaction, as well as long-lasting psychological consequences (24) even in peace time. In this study, our aim was to investigate the prevalence of essential arterial hypertension in the family members of soldiers killed during the 1992-1995 war in Bosnia and Herzegovina, with the hypothesis that mourning may represent a stress that could affect arterial blood pressure.     

Acral peeling skin syndrome: a clinically and genetically heterogeneous disorder

Acral peeling skin syndrome (APSS) is a rare, autosomal, recessive genodermatosis characterized by painless spontaneous exfoliation of the skin of the hands and feet at a subcorneal or intracorneal level. It usually presents at birth or appears later in childhood or early adulthood. Some cases result from mutations in the TGM5 gene that encodes transglutaminase 5, which has an important role in cross-linking cornified cell envelope proteins. We report a new APSS pedigree from Jordan that contains at least 10 affected family members, although sequencing of the TGM5 gene failed to disclose any pathogenic mutation(s). On the basis of probable consanguinity, we performed homozygosity mapping and identified areas of homozygosity on chromosomes 1, 6, 10, 13, and 16, although none of the intervals contained genes of clear relevance to cornification. APSS is a clinically and genetically heterogeneous disorder, and this Jordanian pedigree underscores the likelihood of still further heterogeneity.     

The effects of masseter muscle paralysis on facial bone growth

BACKGROUND: Understanding the effects of muscle function on facial bone growth may help us treat children with facial anomalies. Facial bone growth is known to be a result of both genetic and epigenetic influences. One of the main epigenetic factors controlling growth is thought to be muscle action. The purpose of this study was to establish a model of single facial muscle paralysis and to identify the effects masseter muscle paralysis has on mandible and zygoma growth. METHODS: Twenty New Zealand white rabbits were divided into control, paralysis, and sham groups. Masseter muscle paralysis was achieved with botulinum toxin A (BTX). Computed tomographic and single-photon emission computed tomography (SPECT) scans and cephalometric measurements were performed. Masseter weights and mandible and zygoma volumes, shapes, and metabolism were measured. RESULTS: Eighteen animals completed the study. Significant decreases in zygoma and mandible volumes with minimal changes in shape were seen on the paralyzed sides. SPECT showed a decrease in bone production in both zygomas and mandibles on the paralyzed sides. CONCLUSIONS: An animal model has been created in which the effects of single muscle paralysis on bone growth can be studied. Masseter muscle function may be responsible in maintaining mandible and zygoma volume by controlling bone production. Masseter function alone has less influence on mandible and zygoma shape.     

Regional differences in epidermal thickness and behavioral response following partial denervation of the rat paw

In order to investigate the relation between changes in epidermal thickness and pain-related behavior in different rat hind paw areas we performed partial denervation using two experimental models of neuropathic pain injury: spinal nerve ligation (SNL) and chronic constriction injury (CCI). Denervation produced significant epidermal thinning in both models. The most pronounced thinning was observed in the lateral paw region of the SNL group. Both models showed increase in hyperalgesic response during the postoperative period and no behavioral differences between testing regions. Our study showed that partial denervation induces regional differences in epidermal thinning but not in pain-related behavior.