This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Strawn, J. R. Articles by Geracioti, T. D. Search for Related Content PubMed PubMed Citation Articles by Strawn, J. R. Articles by Geracioti, T. D., Jr. Related Collections PTSD Sympathetic Nervous System Stress and Coping Blood Pressure

Blood Pressure and Cerebrospinal Fluid Norepinephrine in Combat-Related Posttraumatic Stress Disorder

From the Department of Psychiatry (J.R.S., N.N.E., D.G.B., T.D.G.), College of Medicine, University of Cincinnati, Cincinnati, Ohio; the Psychiatry Service (J.R.S., N.N.E., D.G.B., T.D.G., P.S.H.), Veterans Affairs Medical Center, Cincinnati, Ohio; and the Department of Mathematical Sciences (P.S.H.), University of Cincinnati, Cincinnati, Ohio.

Address correspondence and reprint requests to Jeffrey R. Strawn, Psychiatry Service, Veterans Affairs Medical Center, 3200 Vine Street, Cincinnati, OH 45220. E-mail: strawnjr{at}uc.edu

OBJECTIVE: Central nervous system norepinephrine (NE) is normally involved in blood pressure regulation, but it is pathophysiologically elevated in posttraumatic stress disorder (PTSD).

METHODS: We monitored blood pressure while performing serial cerebrospinal fluid (CSF) sampling for 6 hours to determine CSF NE concentrations in men with combat-related PTSD (n = 11) and in healthy men (n = 8).

RESULTS: CSF NE concentrations strongly and positively correlated with mean diastolic blood pressure in the healthy men (R = 0.93, p < .002) but not in the patients (R = 0.10, p = .77). Within individuals, mean arterial pressure, systolic blood pressure, diastolic blood pressure and pulse pressure were poorly correlated over time in patients with PTSD but highly correlated over time in the healthy men, indicating that measurement of these hemodynamic parameters are poorly prognostic of subsequent measurements of the same parameter in patients with PTSD.

CONCLUSION: These data demonstrate the loss of the normal direct relationship between CSF NE and blood pressure in combat veterans with PTSD. Whether this dysynchrony mechanistically relates to the hemodynamic abnormalities in PTSD or, like some of the psychobehavioral symptoms, can be corrected with anti-noradrenergic pharmacotherapy remains to be determined.

Key Words: NE, • autonomic nervous system, • central nervous system, • cerebrospinal fluid, • posttraumatic stress disorder, • mean arterial pressure.

Abbreviations: NE = norepinephrine;; CNS = central nervous system;; PTSD = posttraumatic stress disorder;; CSF = cerebrospinal fluid;; MAP = mean arterial pressure;; BMI = body mass index;; AR = autoregressive order 1 model.