Cardiovascular reactivity to mental stress in premenopausal women with PTSD

Introduction: Evidence is accumulating for a high risk of early onset hypertension and CVD in premenopausal women diagnosed with posttraumatic stress disorder (PTSD). The physiological mechanisms underlying this heightened risk prior to menopause are still being elucidated. The cardiovascular reactivity hypothesis posits that individuals with an exaggerated heart rate (HR) and blood pressure (BP) reactivity to a laboratory stressor such as a mental arithmetic stress task have a higher risk of developing hypertension later in life. Thus, this study compared HR and BP responses to mental stress in a group of trauma-exposed premenopausal women. We hypothesized that the cardiovascular excitation associated with acute stress would be greater in women with PTSD compared to trauma-exposed women without PTSD. Methods: Twenty premenopausal women with PTSD (PTSD+, 26± 5 years) and nineteen premenopausal women without PTSD (PTSD-, 25±5 years) were examined during 5-minutes supine baseline and 5-minutes of mental stress (via mental arithmetic). Beat-to-beat HR and BP were measured using three-lead EKG and non-invasive BP recordings respectively. The reactivity to stress was calculated as the mean value for each consecutive minute of mental arithmetic minus the corresponding 5-min mean baseline. The minute-by-minute reactivity was analyzed using a repeated measures ANOVA with “PTSD diagnosis” as between-subjects factor and “timepoint” as within-subjects factor. Baseline characteristics were compared using an unpaired t-test. Results: Body mass index was comparable between the groups (p=0.069). At rest, seated systolic BP (109±9 vs 110±8 mmHg, p=0.635) and diastolic BP (73±10 vs 69±8 mmHg, p=0.166) were comparable between PTSD+ and PTSD- respectively. In contrast, seated HR (88±14 vs 75±9 beats/min, p=0.002) was higher in PTSD+ compared to PTSD-. As expected, PTSD+ had higher PTSD symptom severity scores assessed via the PTSD checklist for DSM-5 (40±11 vs 25±10 a.u., p< 0.001) compared to PTSD-. Over the course of the 5 min mental stress, systolic (timepoint × diagnosis, p=0.009) and diastolic (timepoint × diagnosis, p=0.021) BP reactivity was significantly higher in PTSD+ compared to PTSD-. Likewise, HR reactivity was higher (timepoint × diagnosis, p=0.012) in PTSD+ compared to PTSD-. Given that depression is comorbid in PTSD, we adjusted for depression symptom severity in our reactivity analysis and the result remains consistent. Conclusion: In summary, women with PTSD demonstrated overall higher cardiovascular responsiveness to mental stress compared to women without PTSD. These findings suggest that, despite expected cardiovascular protection during the premenopausal period in women, a diagnosis of PTSD may indeed be associated with a higher risk of developing hypertension and CVD. This abstract was presented at the American Physiology Summit 2026 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.