www.medscape.com
?By Lisa Nainggolan?
July 13, 2012 (Penrith, Australia) ? A large new study of over 40 000 postmenopausal women has found that use of hormone replacement therapy (HRT) is associated with an increased risk of high blood pressure [1]. The results also show, for the first time, that the risk of hypertension rises with longer duration of HRT use, say Dr Christine L Chiu (University of Western Sydney, Penrith, Australia) and colleagues in PLoS One.
And importantly, "the association between using HRT and high blood pressure was more prominent for younger postmenopausal women, aged 45?55 years," senior author Dr Joanne M Lind (University of Western Sydney) told heartwire . "By the time women reached their 70s, the impact was not significant anymore."
We recommend that doctors take into consideration the fact that HRT could increase the odds of having high BP and if possible minimize the length of time that women take it.
Lind notes that it is "still only an association, we don't know the direct cause. But we do know that of the women who'd used HRT, more of them had high BP compared with the women who'd never used it. We recommend that doctors take into consideration the fact that HRT could increase the odds of having high BP and if possible minimize the length of time that women take it." She and her fellow authors also recommend that BP should be closely monitored both during and after use of hormone therapy, and that women be made aware that hypertension is a possible risk of HRT use.
Risk of Hypertension Rose With HRT in Younger Women
Most of the studies conducted to date have focused on the risk of myocardial infarction and stroke from HRT, and of those studies that have investigated the relationship between HRT and blood pressure, the findings have been largely inconsistent, Chiu and colleagues state in their paper. Using data from the 45 and Up Study of healthy aging, which Lind notes is the "largest of its kind in the Southern hemisphere," they set out to ascertain the association between HRT use and hypertension, and whether the number of years spent taking HRT was associated with risk.
A total of 43 405 postmenopausal women, average age around 63 years, were included, all of whom had an intact uterus, had gone through menopause, and had not started HRT and did not have hypertension prior to menopause. Of the 12 443 women who had used HRT (past or current), 20% self-reported having high BP compared with 17% of the 30 962 women who had never used it.
In that younger age group, any length of time they took HRT was associated with higher odds [of hypertension that] .?.?.?just kept on increasing the longer a woman had taken it.
The researchers note they could not account for the different types of HRT taken by women in the study, as that information was not available.
After adjusting for demographic and lifestyle factors, odds ratios for the association between HRT use and hypertension was 1.59 for those <56 years, 1.58 for those aged 56?61 years, and 1.26 for those aged 62?70 years. Women who had used HRT at any time were first diagnosed with hypertension 2.8 years earlier than women who had never used it.
"In that younger age group, any length of time they took HRT was associated with higher odds [of hypertension], and those odds just kept on increasing the longer a woman had taken it," Lind noted adding, "no one has shown that before."
But as women got older, the association between HRT use and hypertension diminished, she adds.
Longer Follow-Up Needed
Lind says some of the older studies that examined HRT and BP even found a slight reduction in BP in women who taking such therapy "but they haven't looked at the long-term effects," she says, adding that this information is sorely needed.
"A clinical trial of HRT, which includes an extended period of follow-up after cessation of treatment, is required to decipher how HRT leads to higher odds of having high blood pressure. Such a trial should initiate HRT close to menopause and only include women who have never used HRT previously," she and her colleagues conclude.
The authors report no conflicts of interest.
References
1.??????????? Chiu CL, Lujic S, Thornton C, et al. Menopausal hormone therapy is associated with having high blood pressure in postmenopausal women: observational cohort study. PLoS ONE 2012;7:e40260. Available at: http://www.plosone.org.
Heartwire???2012?Medscape, LLC
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