The impact of war-induced stress on arterial hypertension, cerebrovascular dysfunction and vascular aging: protocol of a prospective study among Ukrainian female refugees

Background: The brain has been traditionally regarded as the victim of hypertension. The link between hypertension and cerebrovascular dysfunction is bilateral, and the latter may also play a role as the culprit. The current war in Ukraine is causing exposure of millions of inhabitants to traumatic experiences and severe stress. Part of the Ukrainian population was induced to leave the country for escaping war. We report the protocol of a prospective study aiming at the assessment of the impact of war-induced stress on hypertension, cerebrovascular dysfunction, and vascular aging in Ukrainian refugee women moved to Poland. Material and methods: The study will be conducted in 3 stages. Stage 1 will assess the development and validation of a method for integrated measurement of cerebrovascular function, neuroanatomical connectivity alterations, and vascular aging in Ukrainian refugees (present in Poland) with war-induced stress. In Stage 2, we will study the prevalence, features, correlates, and consequences of cerebrovascular dysfunction and neuronal functional reorganization depending on the presence/absence of war-induced stress and hypertension; the contribution of cerebrovascular function, neuroanatomical connectivity alterations, and vascular aging to the development of hypertension. Stage 3 will assess the associations between hormonal activity, neuroanatomical connectivity alterations, and vascular aging in patients with post-traumatic stress disorders and hypertension. Discussion: This study will test the hypothesis that psychological stress and trauma exposure may contribute to cerebrovascular dysfunction development/worsening and affect vascular aging. Furthermore, we will test whether these abnormalities will be different in hypertensive and normotensive women. The results should significantly advance understanding of the mechanisms underlying the development and progression of cerebrovascular dysfunction and vascular aging. Research study registration number 1232576.