Estrogen formulation, dosage and years since menopause influence hypertension risk
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Estrogen dosage, the type of formulation and the number of years since menopause may alter a woman’s risk for hypertension, according to data from the Women’s Health Initiative Observational Study published in Menopause.
“The risk [for hypertension] is greater with age, even considering dose,” Robert A. Wild, MD, MPH, PhD, the President’s Associates Presidential Professor and vice chair for research and development in the department of obstetrics/gynecology, biostatistics and epidemiology at the Oklahoma University Health Sciences Center in Oklahoma City, told Healio. “Transdermal seemed to be associated with less risk. Other estrone products compared to Premarin (Pfizer) had less risk.”
Wild and colleagues analyzed data from 19,986 women without diagnosed hypertensionwho participated in the WHI Observational Study. Women self-reported the type of hormone therapy used, HT doses, risk factors, clinical events and demographics. Blood pressure was recorded at study enrollment. The primary outcome of treated hypertension was based on self-reports of any hypertension medication collected annually, or a BP of 140/90 mm Hg reported at the 3-year in-person clinic visit. Women using oral conjugates estrogen reported whether they took a low dose of less than 0.625 mg, a conventional dose of 0.625 mg or a high dose of more than 0.625 mg. Other estrogen types included in the study were oral estradiol, other estrone sulfate dominant products, transdermal estrogens and oral estrogen with a progestogen.
Of the study participants, 89% were white women and most used conventional doses of oral conjugated estrogens. At year 3, women using transdermal estrogen (OR = 0.85; 95% CI, 0.73-1) or estrone sulphate dominant preparations (OR = 0.83; 95% CI, 0.72-0.96) had a lower likelihood for hypertension compared with those taking a conventional dose of oral conjugated estrogen. There were no differences in hypertension risk by oral conjugated estrogen dose, although higher doses were associated with the highest likelihood for treatment for hypertension. All preparations other than a conventional dose of oral conjugated estrogen were associated with lower systolic BP.
In subgroup analysis, women 10 or more years past menopause had higher risk for self-reported hypertension when taking a high-dose oral conjugated estrogen compared with a conventional dose (HR = 1.26; 95% CI, 1.09-1.46). Women less than 10 years past menopause had a lower risk for hypertension with high-dose oral conjugated estrogen compared with a conventional dose (HR = 0.87; 95% CI, 0.68-1.13; P for trend interaction = .006).
“Lower doses, the transdermal route and/or using estrone sulphate preparations were each associated with lower risk,” the researchers wrote. “Starting with a dose higher than conjugated estrogen 0.625 mg 10 years past menopause was associated with a greater likelihood of treated hypertension. Our findings further inform decision-making regarding HT use in postmenopausal women and they offer more precision.”
Wild said more studies are needed to determine hypertension risk with newer lower-dose options of estrogen.
For more information:
Robert A. Wild, MD, MPH, PhD, can be reached at robert-wild@ouhsc.edu.
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Wild RA, et al. Menopause. 2021;doi:10.1097/GME.0000000000001828.
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