All veterans had at least 1 comorbid medical condition, and the majority had multiple medical comorbidities. All were taking multiple medical and psychiatric medications. More than 80% of veterans were taking antihypertensive agents at baseline (Table 6). Twenty-two of the 32 veterans were prescribed a VA/DoD PTSD guideline-recommended antidepressant.
Primary Outcomes
The baseline, final, and changes in the primary outcomes are included in the Figure. Treatment with prazosin was associated with significant improvement in median scores from baseline to endpoint for CAPS nightmare frequency (-2, P = .0001), CAPS nightmare intensity (-2, P = .001), and total CAPS item score (-4, P < .001).
Secondary Outcomes
Of the 32 patients included in the study, PCL-5 was obtained from 20 veterans and ISI from 17 veterans at discharge from clinic. Thirty veterans reported final sleep hours, 2 veterans were unable to quantify average sleep hours per night at their final visit. PTSD symptom severity showed significant median change from baseline to endpoint of management in PTC for PCL-5 (-20.5, P = .0002) and ISI (-6.5, P = .002). Total sleep hours also showed significant improvement from baseline to endpoint (1.5, P = .003) (Table 7).
Prazosin Dosing
Maximum prazosin total daily doses were evaluated from the study baseline to the endpoint (Table 8). The mean (SD) maximum total daily dose of prazosin reached was 5.6 (5.1) mg (median, 3.5 mg; range, 1-17 mg). The mean (SD) total daily dose of prazosin at endpoint of study was 5.1 (5.3) mg (median, 2.5 mg; range, 0-17 mg). The average (SD) change of prazosin dose from baseline to endpoint was 3.5 (4.6) mg (median, 2 mg; range, -2 to 15 mg).
Tolerability
The average (SD) baseline systolic BP (SBP) was 135.8 (20.5) mm Hg and diastolic BP (DBP) was 77.2 (11.0) mm Hg. The average SBP and DBP at study endpoint were 131.8 (16.6) mm Hg and 75.9 (13.7) mm Hg, respectively. Endpoint BP values were missing for 6 patients.
Nine of 32 veterans reported AEs during PTC management of prazosin. Dizziness was the most common AE reported. Other AEs noted included orthostatic hypotension, headache, and falls. Of 12 reported AEs, 8 were related to dizziness, 5 of which were transient or tolerable. One veteran had a dose reduction of prazosin due to dizziness, and 3 veterans discontinued prazosin due to orthostasis. Several veterans had changes made to their antihypertensive medication regimen during prazosin titration, including dose reductions and/or decreased number of medications. If indicated, the MH CPS collaborated with the antihypertensive prescriber to make dosing adjustments. Two veterans reported a fall during prazosin titration; 1 veteran had other mobility-related factors thought to precipitate to their fall, and neither veterans were injured because of the falls.
Twenty-eight veterans (87.5%) treated in the PTC continued prazosin therapy after discharge. Six months postdischarge, 70% of veterans had maintained prazosin therapy. Two veterans required a dose increase postdischarge from PTC, and 1 veteran required a dose reduction. About one-third of veterans included in this study continued in the PTC beyond the end of the study period. Common reasons for clinic discharge were symptom resolution (37.5%), adverse reactions (12.5%), lost to follow-up (6.3%), or nonadherence (3.1%).