激素治疗制剂、剂量、给药途径和高血压风险：来自妇女健康倡议观察研究（WHI-OS）的发现。

Hormone therapy formulation, dose, route of delivery, and risk of hypertension: findings from the Women's Health Initiative Observational Study (WHI-OS).

机构信息

Department of Obstetrics and Gynecology, Biostatistics and Epidemiology, Family and Preventive Medicine University of Oklahoma Health Sciences Center, Oklahoma City, OK.

Statistical Research Associate, Fred Hutchinson Cancer Research Center, Seattle, WA.

出版信息

Menopause. 2021 Jul 26;28(10):1108-1116. doi: 10.1097/GME.0000000000001828.

DOI:10.1097/GME.0000000000001828

PMID:34313617

Abstract

OBJECTIVE

Using data from the Women's Health Initiative Observational Study (WHI-OS), to determine the role of estrogen formulation, dose, route of delivery, and its combination with different progestogens on the risk for hypertension in the WHI-OS.

METHODS

After excluding women with diagnosed hypertension, receiving antihypertensive medication, presenting with elevated blood pressure ( ≥ 140/90), and those not taking menopausal hormone therapy at baseline, 19,986 women remained eligible for the analyses. Using hierarchal modeling, proportional hazard rate calculation, and linear and logistic regression analyses, we evaluated incident treated hypertension and mean systolic and diastolic blood pressure changes at 3 years. Multivariable models were adjusted for age, race/ethnicity, education, smoking, physical activity, body mass index, history of treated diabetes, history of prescription medicines for high cholesterol, alcohol intake, hysterectomy, and bilateral oophorectomy.

RESULTS

At 3 years, and compared with conjugated estrogens (CEE) with or without a progestin, the odds for newly treated hypertension were lower in women who used transdermal estradiol (0.85, 95% CI, 0.73-1.00) or oral estrone sulphate dominant preparations (0.83, 0.72-0.96). The odds of incident treated hypertension after 3 years did not vary according to dose of estrogen. The mean measured systolic blood pressure was minimally lower with transdermal estradiol (-1.20, 95% CI, -1.97 to -0.44) mm Hg and other oral Estrone dominant preparations (-0.83, 95% CI, -1.51 to -0.16) mm Hg at 3 years. For a given estrogen type, the magnitudes of the hazard ratio were similar for estrogen-alone compared with estrogen plus a progestogen. For women 10 or more years past menopause when they entered, the HR for incident self-reported treated hypertension was 1.26 (95% CI, 1.09-1.46) with higher dose CEE compared with 0.625 mg CEE. It was 0.87 (95% CI, 0.68-1.13) when given to women who were < 10 years after menopause when they entered the WHI-OS.

CONCLUSION

The risk of treated hypertension differed by formulation, dose, and years since menopause.

摘要

目的

利用来自妇女健康倡议观察研究（WHI-OS）的数据，确定雌激素制剂、剂量、给药途径及其与不同孕激素联合应用对 WHI-OS 中高血压风险的影响。

方法

排除诊断为高血压、服用降压药物、血压升高（≥140/90mmHg）以及基线时未服用绝经激素治疗的女性后，19986 名女性符合分析条件。使用层次建模、比例风险率计算、线性和逻辑回归分析，我们评估了 3 年内新发治疗性高血压和平均收缩压和舒张压变化。多变量模型调整了年龄、种族/民族、教育程度、吸烟、体力活动、体重指数、治疗糖尿病史、处方降胆固醇药物史、饮酒量、子宫切除术和双侧卵巢切除术。

结果

在 3 年内，与雌二醇结合（CEE）加或不加孕激素相比，使用经皮雌二醇（0.85，95%CI，0.73-1.00）或口服雌酮硫酸盐为主的制剂（0.83，0.72-0.96）的女性新发治疗性高血压的几率较低。3 年后新发治疗性高血压的几率与雌激素剂量无关。经皮雌二醇（-1.20，95%CI，-1.97 至-0.44）和其他口服雌酮为主的制剂（-0.83，95%CI，-1.51 至-0.16）的平均收缩压测量值在 3 年内略有降低。对于给定的雌激素类型，与单独使用雌激素相比，雌激素加孕激素的危害比相似。对于进入 WHI-OS 时绝经后 10 年或更长时间的女性，与使用较高剂量 CEE 相比，报告的新发治疗性高血压的 HR 为 1.26（95%CI，1.09-1.46）。当 WHI-OS 中进入的女性绝经后 <10 年时，给予 0.625mg CEE，HR 为 0.87（95%CI，0.68-1.13）。