Elevated BP in early postmenopause tied to higher white matter lesion risk
Key takeaways:
- Higher systolic and diastolic blood pressure for recently postmenopausal women was tied to greater white matter hyperintensity later in life.
- Menopausal hormone therapy use did not modify this association.
Recently postmenopausal women with elevated blood pressure but no other CVD risk factors were more likely to develop white matter lesions 14 years later, regardless of short-term hormone therapy use, data show.
“Beyond the influence of advanced age, hypertension emerges as a significant modifiable risk factor for white matter hyperintensity, with its risk profile notably increasing during the menopausal transition,” Firat Kara, PhD, assistant professor in the department of radiology at Mayo Clinic, and colleagues wrote in Menopause. “Although midlife vascular health is important for the brain, whether an increase in systolic and diastolic BPs around the time of menopause in women with low CVD risk is associated with white matter hyperintensity volume later in life is unclear.”
Kara and colleagues analyzed data from 257 postmenopausal women (mean age, 67 years) who participated in the Kronos Early Estrogen Prevention Study (KEEPS) continuation trial, assessed 10 years after completion of KEEPS. During KEEPS, researchers randomly assigned participants to short-term 17-beta estradiol (n = 85), oral conjugated equine estrogens (n = 74) or placebo (n = 98).
Researchers examined the associations between baseline BP of participants in KEEPS with white matter hyperintensity volume during the KEEPS continuation study.
At baseline, the median systolic and diastolic BP were 117/74 mm Hg. During the KEEPS continuation study, median white matter hyperintensity volume was 5.27 cm3.
In linear regression models, researchers found that elevated baseline systolic BP (beta = 0.006; 95% CI, –0.006 to –0.02) and elevated baseline diastolic BP (beta = 0.01; 95% CI, 0.002-0.03) was associated with greater white matter hyperintensity volume measured 14 years later. Additional analyses showed the association was independent of hypertension status; results remained similar after adjusting for other CVD risk factors.
Researchers observed no evidence that menopausal HT modified the association between BP and white matter hyperintensity.
“Although our results do not directly show that maintaining normal BP during the early postmenopausal period could be beneficial for long-term brain health, further research is needed to confirm whether interventions to maintain BP within the normal range directly reduce or slow down white matter injury,” the researchers wrote. “Although menopausal HT is critical in treating vasomotor symptoms of menopause, our study provides evidence that short-term menopausal HT exposure did not have any adverse or beneficial effects on the association between baseline BP and later white matter hyperintensity volume.”