Hormone Replacement Therapy and Longitudinal Changes in Blood Pressure in Postmenopausal Women

21 August 2001 | Volume 135 Issue 4 | Pages 229-238

Background: The incidence of hypertension in postmenopausal women exceeds that in age-matched men. Longitudinal studies relating hormone replacement therapy (HRT) to blood pressure changes are sparse.

Objective: To investigate the association between HRT and longitudinal changes in blood pressure in postmenopausal women.

Design: Longitudinal observational study.

Setting: Community-dwelling volunteers.

Patients: 226 healthy, normotensive postmenopausal women from the Baltimore Longitudinal Study of Aging with a mean (±SD) age of 64 ± 10 years were followed for 5.7 ± 5.3 years. Seventy-seven women used both estrogen and progestin, and 149 used neither.

Measurements: Lifestyle variables, blood pressure, and traditional cardiovascular risk factors were measured at baseline and approximately every 2 years thereafter.

Results: Systolic blood pressure at baseline was similar in HRT users and nonusers (133.9 ± 16.0 mm Hg vs. 132.4 ± 14.8 mm Hg). Over time, average systolic blood pressure increased less in HRT users than nonusers, independent of other cardiovascular risk factors, physical activity, and alcohol use. For example, HRT users who were 55 years of age at their first Baltimore Longitudinal Study of Aging visit experienced a 7.6–mm Hg average increase in systolic blood pressure over 10 years; in contrast, the average increase in nonusers was 18.7 mm Hg. The lesser increase in systolic blood pressure in HRT users was more evident at older age. Diastolic blood pressure, which did not change statistically over time in either group, was not associated with HRT.

Conclusion: Postmenopausal women taking HRT have a smaller increase in systolic blood pressure over time than those not taking HRT. This difference is intensified at older ages.

Author and Article Information

From Gerontology Research Center, National Institute on Aging, National Institutes of Health, and Johns Hopkins University School of Nursing, Baltimore, Maryland.

Acknowledgments: The authors thank the physicians, nurses, and physician assistants of the Baltimore Longitudinal Study on Aging staff for careful measurement of blood pressure over the years; Dr. Reubin Andres, who provided the data on blood lipids and developed the blood pressure database; and the dedicated Baltimore Longitudinal Study on Aging volunteers who participated in the study.

Requests for Single Reprints: Jerome L. Fleg, MD, Laboratory of Cardiovascular Science, Gerontology Research Center, National Institute on Aging, National Institutes of Health, 5600 Nathan Shock Drive, Baltimore, MD 21224.

Current Author Addresses: Dr. Scuteri: U.O. Geriatria, INRCA, via Cassia 1167, 00189 Rome, Italy.

Dr. Bos: Pontificia Universidade Católica do Rio Grande do Sul, Instituto de Geriatria, Avenida Ipiranga 6690, Caixa Postal 1429, Porto Alegre RS, Brazil.

Dr. Brant: Statistical Studies Section, Gerontology Research Center, National Institute on Aging, National Institutes of Health, 5600 Nathan Shock Drive, Baltimore, MD 21224.

Dr. Talbot: Johns Hopkins University, 525 North Wolfe Street, Baltimore, MD 21205.

Drs. Lakatta and Fleg: Laboratory of Cardiovascular Science, Gerontology Research Center, National Institute on Aging, National Institutes of Health, 5600 Nathan Shock Drive, Baltimore, MD 21224.

Author Contributions: Conception and design: A. Scuteri, A.J.G. Bos, E.G. Lakatta, J.L. Fleg.

Analysis and interpretation of the data: A. Scuteri, A.J.G. Bos, L.J. Brant, E.G. Lakatta, J.L. Fleg.

Drafting of the article: A. Scuteri, A.J.G. Bos, L.J. Brant, E.G. Lakatta, J.L. Fleg.

Critical revision of the article for important intellectual content: A. Scuteri, L.J. Brant, E.G. Lakatta, J.L. Fleg.

Final approval of the article: A. Scuteri, A.J.G. Bos, J.L. Fleg.

Provision of study materials or patients: A.J.G. Bos, L. Talbot.

Statistical expertise: A. Scuteri, A.J.G. Bos, L.J. Brant.

Collection and assembly of data: L. Talbot.