Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, 900 Commonwealth Ave., Boston, MA 02215, USA.
Atherosclerosis. 2012 Sep;224(1):228-34. doi: 10.1016/j.atherosclerosis.2012.07.005. Epub 2012 Jul 20.
Sex steroid hormones have been postulated to involve in blood pressure (BP) regulation. We examine the association of endogenous sex hormone levels with longitudinal change of BP and risk of developing hypertension in initially normotensive postmenopausal women.
We conducted prospective analysis among 619 postmenopausal women free of hypertension at baseline in the Multi-Ethnic Study of Atherosclerosis (MESA). Change of BP and development of incident hypertension were assessed during a mean of 4.8 years follow-up.
After adjusting for age, race/ethnicity, and lifestyle factors, baseline serum estradiol (E(2)), total and bioavailable testosterone (T), dehydroepiandrosterone (DHEA) were each positively associated and sex-hormone binding globulin (SHBG) was inversely associated with risk of hypertension. Additional adjustment for body mass index eliminated the associations for E(2) and T but only attenuated the associations for DHEA and SHBG. The corresponding multivariable hazard ratios (95% CIs) in the highest quartile were 1.28 (0.83-1.97) for E(2), 1.38 (0.89-2.14) for total T, 1.42 (0.90-2.23) for bioavailable T, 1.54 (1.02-2.31) for DHEA, and 0.48 (0.30-0.76) for SHBG. Adjustment for fasting glucose, insulin, and C-reactive protein further attenuated the association for DHEA but not for SHBG. Associations of sex hormones with longitudinal BP change were similar.
In postmenopausal women, higher endogenous E(2), T, and DHEA and lower SHBG were associated with higher incidence of hypertension and greater longitudinal rise in BP. The associations for E(2), T, and DHEA were mostly explained by adiposity, while the association for SHBG was independent of measures of adiposity, insulin resistance, and systemic inflammation.
性激素被认为参与血压（BP）调节。我们研究内源性性激素水平与初诊血压正常的绝经后女性纵向血压变化及高血压发病风险的相关性。
我们对基线时无高血压的 619 例绝经后妇女进行了多民族动脉粥样硬化研究（MESA）的前瞻性分析。在平均 4.8 年的随访期间评估了血压变化和新发高血压的发生情况。
在校正年龄、种族/民族和生活方式因素后，基线时血清雌二醇（E2）、总睾酮（T）和生物可利用睾酮（T）、脱氢表雄酮（DHEA）与高血压发病风险呈正相关，性激素结合球蛋白（SHBG）呈负相关。进一步调整体重指数（BMI）后，E2 和 T 的相关性消失，但 DHEA 和 SHBG 的相关性仅减弱。最高四分位组的相应多变量危险比（95%可信区间）为 E2 1.28（0.83-1.97）、总 T 1.38（0.89-2.14）、生物可利用 T 1.42（0.90-2.23）、DHEA 1.54（1.02-2.31）和 SHBG 0.48（0.30-0.76）。进一步调整空腹血糖、胰岛素和 C 反应蛋白后，DHEA 的相关性进一步减弱，但 SHBG 无变化。性激素与纵向血压变化的相关性相似。
在绝经后女性中，较高的内源性 E2、T 和 DHEA 和较低的 SHBG 与高血压发病率较高和纵向血压升高幅度较大相关。E2、T 和 DHEA 的相关性主要由肥胖解释，而 SHBG 的相关性与肥胖、胰岛素抵抗和全身炎症的测量无关。
