AUTHOR=Kalenga Cindy Z. , Hay Jacqueline L. , Boreskie Kevin F. , Duhamel Todd A. , MacRae Jennifer M. , Metcalfe Amy , Nerenberg Kara A. , Robert Magali , Ahmed Sofia B. 

TITLE=The Association Between Route of Post-menopausal Estrogen Administration and Blood Pressure and Arterial Stiffness in Community-Dwelling Women

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.913609

DOI=10.3389/fcvm.2022.913609

ISSN=2297-055X

ABSTRACT=Background: Postmenopausal hormone therapy (HT) is associated with increased cardiovascular risk. Although the route of estrogen administration may play a role in mediating risk, previous studies have not controlled for concomitant progestin use. 
Objective: To investigate the association between the route of estrogen therapy (oral or non-oral) HT use, without concomitant progestin, on blood pressure and arterial stiffness in postmenopausal women.
Methods: Systolic blood pressure [SBP], diastolic blood pressure [DBP]), arterial stiffness (aortic pulse wave velocity [aPWV] and augmentation index at 75 beats per minute [AIx]) were measured using a validated automated brachial cuff-based oscillometric approach (Mobil-O-Graph) in a community-dwelling sample of 328 women. 
Results: Fifty-five participants (16.8%) were ever users (current and past use) of estrogen-only HT (oral [n=16], transdermal [n=20], vaginal [n=19]), and 223 were never HT users (control). Ever use of oral estrogen was associated with increased SBP and DBP (Oral: SBP: 136.9 ± 4 mmHg, DBP: 78.6 ± 2 mmHg) compared to use of non-oral estrogen (transdermal: SBP: 118.2 ± 2 mmHg, DBP: 73 ± 1 mmHg; p<0.01 & p=0.012, respectively; vaginal: SBP: 122.8 ± 2 mmHg DBP: 73 ± 2 mmHg; p=0.02 & p=0.01, respectively.) and controls (SBP: 123.8 ± 1 mmHg, DBP: 73.8 ± 1 mmHg, p=0.03, p=0.02, respectively) after adjustment for covariates. aPWV was higher in oral estrogen ever users (9.93 ± 1 m/s) compared to non-oral estrogen (transdermal: 8.57 ± 0.3 m/s, p<0.01; vaginal: 8.8 ± 0.7 m/s, p=0.03) and controls (8.85 ± 0.5 m/s, p=0.03) but these associations were no longer significant after adjustment for covariates. AIx was higher in oral estrogen (28.87 ± 2 %) compared to non-oral estrogen (transdermal: 16 ± 2 %; vaginal: 21.9 ± 1.7 %) but this association was no longer significant after adjustment for covariates (p=0.92 vs non-oral; p=0.74 vs control).
Conclusion: Ever use of oral estrogen was associated with increased SBP and DBP compared to non-oral estrogen use and no use. Given the cardiovascular risk associated with both menopause and increased blood pressure, further studies are required exploring the potential benefits of non-oral estrogen in post-menopausal women.