Endogenous Estrogen Exposure and Hypertension Risk; A Population-based Cohort Study With About 2 Decades of Follow-up

Abstract

Content: The impact of endogenous estrogen exposure (EEE) on hypertension (HTN) incidence has not been investigated yet. Objective: This study aimed to evaluate HTN incidence in women with different endogenous estrogen durations. Methods: Information was gathered from the Tehran Lipid and Glucose Study to conduct current research. At the initiation of the study, 4463 postmenarche normotensive women, including 3599 premenopausal and 864 menopausal women, were included. EEE was calculated for each woman, and they were followed up for the HTN event. According to the EEE, the hazard ratios and 95% confidence intervals (CI) for the HTN event were presented using Cox proportional hazards regression models (unadjusted and adjusted). Results: The median (interquartile range) of follow-up (between menarche and the date of HTN incidence or last follow-up) was 33.2 (25.1, 42.3) years. The event of menopause occurred in 31.8% of participants. The unadjusted model’s findings illustrated that the EEE z-score was inversely associated with HTN incidence in postmenarcheal women [unadjusted hazard ratio (HR) .47, 95% CI .44-.50], meaning that the risk of HTN decreased by 53% for every 1-SD rise in the EEE z-score. After adjusting for potential confounders, the results showed no statistically significant changes (adjusted HR .46, 95% CI .43-.49). In participants with prehypertension at baseline, the hazard of HTN decreased by 56% per 1-SD rise in the EEE z-score. Conclusion: This longitudinal study demonstrated the protective effect of a longer EEE duration on HTN risk, even among those with prehypertension status.