Hypertension After Hormone Therapy Withdrawal
Hypertension After Hormone Therapy Withdrawal
The study enrolled 310 consenting eligible women, including 159 women who remained on HT/ET (group 1), 43 women who have resumed HT/ET (group 2), and 108 women who have not resumed HT/ET or replaced HT/ET with alternative therapies such as over-the-counter remedies for hot flashes (group 3). Participation was high, with less than 1% declining in each of the groups. No between-group differences in reasons for discontinuation were noted. Of the women who discontinued HT/ET (groups 2 and 3), 70.2% discontinued because of adverse media about therapy, 24.5% discontinued because of a physician's recommendation, and 16% discontinued for other reasons. Some cited multiple reasons ( Table 1 ). Women who continued or resumed HT/ET were significantly younger than those who discontinued HT/ET (groups 1 + 2 [64.8 (4.1) y] vs group 3 [66.3 (3.7) y], P < 0.01; Table 2 ). Group 1 was younger than group 2, which in turn was younger than group 3, but not significantly so. Women started HT/ET at 49.1 (5.4) years. The mean (SD) weight was 140.4 (24.9) lb, and the mean (SD) BMI was 24.0 (4.1) kg/m. Women remaining on HT/ET or restarting HT/ET were on HT for a significantly longer time (groups 1 + 2 [15.2 (6.4) y] vs group 3 [10.8 (5.4) y], P < 0.01). No between-group differences in weight, height, BMI, waist-to-hip ratio, and body fat were noted ( Table 2 ). The mean (SD) time off HT for group 2 was 29.3 (28.9) months.
There were no between-group differences in socioeconomic status (SES), ethnicity, income, education, access to health care, types of health insurance, exercise, alcohol intake, or smoking. However, they differed in employment, with those who continued HT being more likely to be employed (P < 0.03) and to hold managerial positions (P < 0.04), particularly in a professional satisfaction subscale (P < 0.04), although the likelihood of holding a managerial position or professional satisfaction was no longer significant when age or ability to work (retired or disabled) was controlled for ( Table 3 ). Ninety-five percent of the participants were white, and 84% had college education ( Table 3 ). No woman discontinued HT/ET because of hypertension. There was no difference in the number of doctor visits or hospitalizations in the last 12 months between those women who stopped and those who did not.
Women on HT/ET scored higher on a quality-of-life scale (groups 1 + 2 > group 3; P < 0.02), particularly with respect to occupation (P < 0.04). However, women not on HT/ET scored higher on a vasomotor scale (group 3 > group 1 [P < 0.05, NS] vs group 2) and on vaginal dryness (group 3 > group 1; P < 0.001; Table 4 ). There was no difference in the depression scale of the Greene Climacteric Scale or in the use of antidepressive medication ( Table 4 and Table 5 ).
Triglycerides were slightly higher in the group remaining on HT/ET ( Table 5 ). There was no between-group difference in blood pressure or cholesterol even when controlling for the use of hypertension-lowering medications or statins, respectively. Women who discontinued HT/ET were on significantly more antihypertensive medications: 27.4% of group 3 (29 of 106) versus 16.6% of group 1 (26 of 157) versus 16.3% of group 2 (7 of 43; Table 5 ). Combining the groups on HT/ET, we found that 16.5% of women currently on HT/ET (33 of 200) were on antihypertensive medications compared with 27.4% of women not on HT/ET (29 of 106, P < 0.04; Table 5 , Fig. 1). These results were significant when controlling for age and weight (P < 0.005; Table 4 ) and time off HT/ET in group 2.
(Enlarge Image)
Figure 1.
Percentage of women on antihypertensive medications. HT, hormone therapy; ET, estrogen therapy.
The results were even more significant (P < 0.003) when hypertension in the family was controlled for. Thus, when controlling for other predictors of hypertension (age, weight, BMI, family history, and heart problems before starting HT), the odds of being on antihypertensive medication were 2.289 times greater for those who were not on HT than for those who were. Years on HT/ET was not significantly related to the use of hypertensive medication. There was no significant difference in the incidence of hypertension, number of women on hypertensive medications, cardiovascular events, cardiovascular disease, or diabetes at baseline or at the start of HT among groups 1, 2, and 3.
Results
The study enrolled 310 consenting eligible women, including 159 women who remained on HT/ET (group 1), 43 women who have resumed HT/ET (group 2), and 108 women who have not resumed HT/ET or replaced HT/ET with alternative therapies such as over-the-counter remedies for hot flashes (group 3). Participation was high, with less than 1% declining in each of the groups. No between-group differences in reasons for discontinuation were noted. Of the women who discontinued HT/ET (groups 2 and 3), 70.2% discontinued because of adverse media about therapy, 24.5% discontinued because of a physician's recommendation, and 16% discontinued for other reasons. Some cited multiple reasons ( Table 1 ). Women who continued or resumed HT/ET were significantly younger than those who discontinued HT/ET (groups 1 + 2 [64.8 (4.1) y] vs group 3 [66.3 (3.7) y], P < 0.01; Table 2 ). Group 1 was younger than group 2, which in turn was younger than group 3, but not significantly so. Women started HT/ET at 49.1 (5.4) years. The mean (SD) weight was 140.4 (24.9) lb, and the mean (SD) BMI was 24.0 (4.1) kg/m. Women remaining on HT/ET or restarting HT/ET were on HT for a significantly longer time (groups 1 + 2 [15.2 (6.4) y] vs group 3 [10.8 (5.4) y], P < 0.01). No between-group differences in weight, height, BMI, waist-to-hip ratio, and body fat were noted ( Table 2 ). The mean (SD) time off HT for group 2 was 29.3 (28.9) months.
There were no between-group differences in socioeconomic status (SES), ethnicity, income, education, access to health care, types of health insurance, exercise, alcohol intake, or smoking. However, they differed in employment, with those who continued HT being more likely to be employed (P < 0.03) and to hold managerial positions (P < 0.04), particularly in a professional satisfaction subscale (P < 0.04), although the likelihood of holding a managerial position or professional satisfaction was no longer significant when age or ability to work (retired or disabled) was controlled for ( Table 3 ). Ninety-five percent of the participants were white, and 84% had college education ( Table 3 ). No woman discontinued HT/ET because of hypertension. There was no difference in the number of doctor visits or hospitalizations in the last 12 months between those women who stopped and those who did not.
Women on HT/ET scored higher on a quality-of-life scale (groups 1 + 2 > group 3; P < 0.02), particularly with respect to occupation (P < 0.04). However, women not on HT/ET scored higher on a vasomotor scale (group 3 > group 1 [P < 0.05, NS] vs group 2) and on vaginal dryness (group 3 > group 1; P < 0.001; Table 4 ). There was no difference in the depression scale of the Greene Climacteric Scale or in the use of antidepressive medication ( Table 4 and Table 5 ).
Triglycerides were slightly higher in the group remaining on HT/ET ( Table 5 ). There was no between-group difference in blood pressure or cholesterol even when controlling for the use of hypertension-lowering medications or statins, respectively. Women who discontinued HT/ET were on significantly more antihypertensive medications: 27.4% of group 3 (29 of 106) versus 16.6% of group 1 (26 of 157) versus 16.3% of group 2 (7 of 43; Table 5 ). Combining the groups on HT/ET, we found that 16.5% of women currently on HT/ET (33 of 200) were on antihypertensive medications compared with 27.4% of women not on HT/ET (29 of 106, P < 0.04; Table 5 , Fig. 1). These results were significant when controlling for age and weight (P < 0.005; Table 4 ) and time off HT/ET in group 2.
(Enlarge Image)
Figure 1.
Percentage of women on antihypertensive medications. HT, hormone therapy; ET, estrogen therapy.
The results were even more significant (P < 0.003) when hypertension in the family was controlled for. Thus, when controlling for other predictors of hypertension (age, weight, BMI, family history, and heart problems before starting HT), the odds of being on antihypertensive medication were 2.289 times greater for those who were not on HT than for those who were. Years on HT/ET was not significantly related to the use of hypertensive medication. There was no significant difference in the incidence of hypertension, number of women on hypertensive medications, cardiovascular events, cardiovascular disease, or diabetes at baseline or at the start of HT among groups 1, 2, and 3.