Association between Surgical Fibroid Removal and Blood Pressure: A Retrospective Case-Control and Prospective Cohort Study

Abstract

<h3>Study Objective</h3> Fibroids, monoclonal proliferations of uterine smooth muscle cells, are common in women and have recently been associated with cardiometabolic risk factors including hypertension. The objective of this study is to determine whether fibroids are biomarker of systemic hypertension, and whether they may contribute to elevation in blood pressure. <h3>Design</h3> IRB-approved retrospective case-control study and prospective cohort study. <h3>Setting</h3> Single academic institution. <h3>Patients or Participants</h3> Retrospective chart review of 313 patients undergoing hysterectomy or myomectomy for fibroids and patients undergoing other surgical procedures for benign gynecological indications with similar demographic characteristics (control). Prospective cohort of 9 women undergoing myomectomy or hysterectomy for fibroids. <h3>Interventions</h3> Hysteroscopy, laparoscopy, open myomectomy or hysterectomy for fibroids (or non-fibroid indications as control). <h3>Measurements and Main Results</h3> In our retrospective cohort (n=294; mean age 41.9±10.6, 43.5% Black, 50% with fibroids), we found consistently that compared to patients without fibroids, patients with fibroids had significantly elevated systolic BP (pre-op 128 vs 122mmHg, p=0.0005; post-op 126 vs 122mmHg, p=0.02) but not diastolic BP (pre-op 77.6 vs 75.9mmHg, p=0.17; post-op 76.7 vs 75.0, p=0.19). Among patients with fibroids, surgical fibroid removal was associated with a small but not statistically or clinically significant drop in systolic (Δ=-2.21mmHg, p=0.062) but not diastolic BP (Δ=-0.93mmHg, p=0.39). The direction and magnitude of effect for change in systolic BP remained consistent after adjustment for age, race, and presence of diagnosed hypertension (β=-2.45, p=0.17). In our prospective cohort, there was a significant decrease in SBP of 9.9mmHg (pre- versus post-operatively), but no change in DBP following fibroid removal (p=0.03, p=0.14, respectively). Serum levels of Ang-II and ACE were not significantly altered following surgical fibroid removal (p=0.39, p=0.80, respectively). <h3>Conclusion</h3> Altogether, these findings demonstrate that fibroids are associated with hypertension and suggest that fibroid removal may lead to a clinically significant decrease in systolic blood pressure. These changes may occur by a mechanism independent of the renin-angiotensin-aldosterone system.