MENOPAUSAL HORMONE THERAPY AND RISK OF INCIDENT HYPERTENSION: IMPACT OF THE ROUTE OF ESTROGEN ADMINISTRATION AND PROGESTOGENS IN THE E3N COHORT

Abstract

Objective: Although menopausal hormone therapy (MHT) remains the most efficacious treatment for vasomotor symptoms of menopause, its effects on the development of arterial hypertension remain unclear. We sought to determine the effect of different formulations of MHT on incident hypertension among menopausal women in a large prospective cohort study. Design and method: We used data from the E3N cohort study, a French prospective population-based study initiated in 1990 of 98,995 women. Out of these, 49,905 menopausal women with complete information on the use of MHT, and without prevalent hypertension at inclusion were included. Hypertension cases were self-reported and validated using the national drug reimbursement database. Results: Among these women with a mean age was 54.2 ± 4.3 years, 10 173 cases of hypertension were identified in an average follow-up time of 10.6 years and 32 183 (64.5%) of the women reported ever using MHT. Compared with women who never used MHT, those who ever used it had an increased risk of incident hypertension (adjusted HR 1.07, 95% CI 1.02–1.12) after adjustment for body mass index and other potential confounders (Table 1). When formulation was taken into account, oral but not transdermal estrogen use was associated with an increased risk of hypertension (adjusted HR = 1.09; 95% CI: 1.04–1.14 and HR = 1.03; 95% CI: 0.99–1.07, respectively). Regarding the impact of concomitant progestogens, pregnane and norpregnane derivatives were significantly associated with hypertension risk (HR = 1.12; 95% CI: 1.06–1.19 and HR = 1.06; 95% CI: 1.01–1.13, respectively). Conclusions: Use of MHT was associated with an increased risk of incident hypertension, especially when using oral estrogen and pregnane and norpregnane derivative in case of combined treatment. Surveillance of blood pressure should be added to the medical surveillance of MHT users.