Endogenous sex hormones are associated with blood pressure change and hypertension incidence in postmenopausal women

Evaluation of: Wang L, Szklo M, Folsom AR et al. Endogenous sex hormones, blood pressure change, and risk of hypertension in postmenopausal women: the Multi-Ethnic Study of Atherosclerosis. Atherosclerosis 224(1), 228-234 (2012). Among the mechanisms involved in blood pressure (BP) regulation, sex steroid hormones may play a significant role. Consistently, premenopausal women have a lower incidence of cardiovascular events than postmenopausal women, possibly due to the cardioprotective role of ovarian hormones on both risk factors and vascular health. However, epidemiologic studies investigating the relationships between endogenous sex hormones and BP or hypertension are mainly cross-sectional and gained inconsistent results. The recent prospective study by Wang et al. on 619 postmenopausal women without baseline hypertension from MESA examined the association of endogenous sex hormone levels with subsequent BP change and hypertension status. The main findings are that higher serum concentrations of estradiol, total and bioavailable testosterone, dehydroepiandrosterone and lower concentration of sex-hormone binding globulin were associated with a risk of hypertension and a greater BP increase. However, the associations with estradiol, testosterone and dehydroepiandrosterone lost significance after adjustments for BMI, whereas the association with lower concentration of sex-hormone binding globulin remained strong and significant. These findings support the hypothesis that sex hormones are involved in BP regulation in menopause.