Hormone therapy effect on BP dictated by estrogen type

In postmenopausal women, hormone therapy (HT) affects blood pressure (BP) differently based on the formulations used, especially the type of estrogen, according to a study.

Specifically, combined formulations of conjugated equine estrogens plus progestogen appears to contribute to increased systolic BP levels and, in turn, hypertension risk—an effect that is not seen with estradiol plus progestogen, estradiol alone, and tibolone.

For the study, researchers performed a systematic review and meta-analysis of randomized clinical trials and prospective observational studies, wherein the effect of HT on BP and its association with arterial hypertension among postmenopausal women was evaluated.

Multiple online databases were searched for relevant literature. The search yielded 11 studies for inclusion in the meta-analysis, with the total population comprising 81,041 postmenopausal women. Effect measures were calculated for BP outcome, and the I2 statistic was used to evaluate heterogeneity. Results were presented based on the type of HT, and the incidence of hypertension was compared using descriptive analyses.

Pooled data from eight studies (n=1,718) showed that users of oral conjugated equine estrogens plus progestogen had elevations in systolic BP levels (standardized mean difference [SMD], 0.60 mm Hg, 95 percent confidence interval [CI], 0.19–1.01).

The effect on systolic BP was not observed among users of estradiol plus progestogen (SMD, −2.00 mm Hg, 95 percent CI, −7.26 to 3.27), estradiol alone, and tibolone.

None of the HT formulations evaluated exerted a significant effect on diastolic BP.

Women who used oral estrogen plus progestogen compared with nonusers also had a higher risk of incident hypertension.