The finding that ACE (angiotensin converting enzyme) inhibitors or ARBs (angiotensin receptor blockers) could aid in the treatment or prevention of PTSD could profoundly impact treatment of the disorder.
“These results are particularly exciting because it’s the first time ACE inhibitors and ARBs have been connected to PTSD, and it gives us a new direction to build on,” said senior author Kerry Ressler, M.D., Ph.D.
However, researchers warn that the findings result from a study of a population, rather than isolated clinical trials. Nevertheless, the resutls suggest that a class of medications whose safety record is well known could be rolled into action quickly.
The results were published online in the Journal of Clinical Psychiatry.
The study, termed the Grady Trauma Project, was an observational study of more than 5,000 low-income Atlanta residents. Individuals studied live with high levels of exposure to violence and physical and sexual abuse, resulting in high rates of civilian PTSD.
All 505 participants in this study were exposed to at least one traumatic event, and around 35 percent of them (180) met the criteria for diagnosis with PTSD. Out of 98 participants taking ACE inhibitors or ARBs, generally for the primary purpose of blood pressure control, 26 had a PTSD diagnosis.
Symptoms of PTSD typically include hyperarousal, avoidance/numbing, and intrusive thoughts. All the participants in the study reported how often they experienced these symptoms and the responses were compiled into a PTSD symptom score.
Patients taking ACE inhibitors or ARBs had an approximately 30 percent decrease in PTSD symptom scores, but no significant differences were apparent for those taking other blood pressure medications, including beta-blockers, calcium channel blockers, and diuretics.
ACE inhibitors or ARBs appear to significantly lower levels of hyperarousal and intrusive thoughts.
Scientists say the results demonstrate the linkage between stress, response to PTSD, and blood pressure regulation. Both ACE inhibitors and ARBs interfere with angiotensin II, a hormone that regulates blood pressure.
Lab research supports the observation that use of blood pressure medication can reduce stress and fear. In fact, lab data suggests that this class of medication may both decrease the body’s physiological response to stress in the cardiovascular system as well as decrease the brain’s response to stress.
However, the finding that beta blockers were not effective was surprising, Ressler says. Some musicians and athletes take beta blockers to relieve performance anxiety symptoms, and some early clinical studies have examined whether they can be used to treat PTSD. Beta blockers diminish the body’s response to the stress hormones norepinephrine and epinephrine.
“Beta blockers did appear to have a trend toward an effect, but the effects of the angiotensin medications were stronger, and when people in our study took both, only the angiotensin medications survived statistical analysis,” Ressler said.
“Beta blockers may be useful in the moment for decreasing social or performance anxiety, but their efficacy in PTSD treatment is still an open question.”
Source: Emory University