Does hormone therapy affect blood pressure changes in the Diabetes Prevention Program?
OBJECTIVE
This study aims to examine whether blood pressure reductions differ by estrogen use among overweight glucose-intolerant women.


METHODS
We conducted a secondary analysis of Diabetes Prevention Program postmenopausal participants who used oral estrogen with or without progestogen at baseline and 1-year follow-up (n = 324) versus those who did not use oral estrogen with or without progestogen at either time point (n = 382). Changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP) were examined by randomization arm (intensive lifestyle change [ILS], metformin 850 mg twice daily, or placebo). Associations between changes in blood pressure and changes in sex hormone-binding globulin, estradiol, testosterone, and dehydroepiandrosterone were also examined.


RESULTS
Estrogen users and nonusers had similar prevalences of baseline hypertension (33% vs 34%, P = 0.82) and use of blood pressure medications at baseline (P = 0.25) and on follow-up (P = 0.10). Estrogen users and nonusers randomized to ILS had similar decreases in SBP (-3.3 vs -4.7 mm Hg, P = 0.45) and DBP (-3.1 vs -4.7 mm Hg, P = 0.16). Among estrogen users, women randomized to ILS had significant declines in SBP (P = 0.016) and DBP (P = 0.009) versus placebo. Among nonusers, women randomized to ILS had significant declines in DBP (P = 0.001) versus placebo, but declines in SBP were not significant (P = 0.11). Metformin was not associated with blood pressure reductions versus placebo regardless of estrogen therapy. Blood pressure changes were not associated with changes in sex hormones regardless of estrogen therapy.


CONCLUSIONS
Among overweight women with dysglycemia, the magnitude of blood pressure reductions after ILS is unrelated to postmenopausal estrogen use.
From the 1Department of Medicine and Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI; 2Department of Medicine, Johns Hopkins University, Baltimore, MD; 3Department of Biostatistics, University of Michigan, Ann Arbor, MI; 4Department of Medicine, Indiana University, Indianapolis, IN; and 5Department of Preventive Medicine, University of California San Diego, La Jolla, CA.
Catherine
C
Kim
Sherita H
SH
Golden
Shengchun
S
Kong
Bin
B
Nan
Kieren J
KJ
Mather
Elizabeth
E
Barrett-Connor
D001794:Blood Pressure / Q000502:physiology*; D001835:Body Weight / Q000502:physiology; D003687:Dehydroepiandrosterone / Q000097:blood; D003920:Diabetes Mellitus / Q000517:prevention & control; D004958:Estradiol / Q000097:blood; D015914:Estrogen Replacement Therapy; D005260:Female; D018149:Glucose Intolerance / Q000503:physiopathology*; D006801:Humans; D008019:Life Style; D008875:Middle Aged; D012738:Sex Hormone-Binding Globulin / Q000032:analysis; D013739:Testosterone / Q000097:blood; D055105:Waist Circumference / Q000502:physiology
D012738:Sex Hormone-Binding Globulin; D013739:Testosterone; D003687:Dehydroepiandrosterone; D004958:Estradiol