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Hypertension in adult survivors of child abuse: observations from the Nurses' Health Study II
  1. E H Riley1,
  2. R J Wright2,3,
  3. H J Jun2,
  4. E N Hibert2,
  5. J W Rich-Edwards4,5
  1. 1Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
  2. 2Channing Laboratory, Brigham and Women's Hospital, Boston, Massachusetts, USA
  3. 3Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA
  4. 4Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, Massachusetts, USA
  5. 5Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
  1. Correspondence to E.H. Riley, 165 Cambridge Street, Suite 501, Boston, MA 02114, USA; ehriley{at}


Background Limited research has shown a possible association between exposure to physical or sexual abuse prior to age 18 and the risk of developing hypertension as an adult. The factors mediating this relationship are unknown.

Methods Questionnaire data from 68 505 female participants in the Nurses' Health Study II were analysed regarding exposure to physical and sexual abuse prior to age 18. Cox proportional hazards regression was used to assess the relationship between abuse exposure and hypertension.

Results 64% of the participants (n=41 792) reported physical and/or sexual abuse prior to age 18; 17% reported hypertension. All forms of abuse had a dose-response relationship with hypertension. Adjustments for smoking, alcohol, family history of hypertension, exercise and oral contraceptives did not alter risk estimates. Adjustment for body mass index (BMI) significantly attenuated the associations between abuse and risk of hypertension and accounted for approximately 50% of the observed association between abuse exposure and hypertension. Women experiencing forced sexual activity as a child and as an adolescent had a 20% increased risk for developing hypertension (95% CI 8% to 32%) that was independent of BMI. Similarly, women reporting severe physical abuse in childhood and/or adolescence had risk estimates ranging from 14% (95% CI 5% to 24%) to 22% (95% CI 11% to 33%).

Conclusion Early interpersonal violence may be a widespread risk factor for the development of hypertension in women. BMI is a significant mediator in the relationship between early abuse and adult hypertension.

  • Child abuse
  • children
  • domestic violence
  • hypertension
  • violence RB
  • women CG

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  • Funding This work was funded by National Institute of Health grants HL081557, CA50385, and HL64108. The study sponsors had no role in the study design, collection, analysis and interpretation of data, writing or editing of the manuscript, or in the decision to submit for publication.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Brigham and Women's Hospital Institutional Review Board and the Human Subjects Committee at Harvard School of Public Health.

  • Provenance and peer review Not commissioned; externally peer reviewed.