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Further Results and Implications of Published and Ongoing Clinical Trials: Hypertension Associated With Presence of Fibroids in Premenopausal Women


Hypertension Associated With Presence of Fibroids in Premenopausal Women

According to research from the Harvard Medical School and Harvard School of Public Health (Boston, Massachusetts), there is a strong and independent association between blood pressure and risk for fibroids in premenopausal women. A prospective study reported in the American Journal of Epidemiology has demonstrated a dose-response relationship between diastolic blood pressure (DBP) and fibroid incidence, with higher DBP associated with increased fibroid risk.[18] Fibroids, also known as uterine leiomyomata or myomas, are the most common gynecologic tumor, occurring almost entirely in premenopausal women. Although fibroids do not often progress to malignancy, symptomatic cases can affect a woman's reproductive health, leading to multiple gynecologic problems such as infertility, spontaneous abortion, pelvic pain, and menstrual abnormalities. At least 20% to 25% of premenopausal women are estimated to have clinically symptomatic fibroids; the incidence appears to be higher among black women.

Hypertension was previously linked to fibroid development through a putative process analogous to atherosclerosis, in which raised blood pressure causes smooth muscle cell injury and/or cytokine release, thereby increasing the risk for fibroid onset or growth. Renée Boynton-Jarrett, SM, and colleagues[18] examined the relation between baseline blood pressure, antihypertensive medication use, and fibroid incidence in 104,233 premenopausal nurses enrolled in the Nurses' Health Study (NHS) II, an ongoing prospective cohort study that began in 1989 in 14 US states. Participants, aged 25-42 years, had intact uteri and no history of cancer or fibroids at enrollment. DBP was the blood pressure measurement used in this study because it has been suggested to be a better indicator of cardiovascular risk than systolic blood pressure (SBP) in younger individuals. Both DBP and incident cases of uterine fibroids (defined as a first diagnosis confirmed by ultrasound or hysterectomy) were self-reported in NHS II.

During the 827,348 woman-years of follow-up (1989-1999), 7466 incident diagnoses of fibroids were reported. With adjustment for age, race/ethnicity, BMI, and reproductive history, for every 10-mmHg increase in DBP, the risk for fibroids rose 8% (5%-11%) and 10% (7%-13%) among women untreated and treated with antihypertensive medications, respectively. This association was not materially altered according to whether the women had had regular gynecologic examinations or had a baseline, more recent, or no diagnosis of hypertension, or by years of hypertension. The association was consistent among white, nonwhite Latino, Asian, and black women. Hypertensive women were 24% (11%-41%) more likely to report fibroids compared with nonhypertensive women.

The Harvard researchers propose attempting to replicate these findings in a cohort study using standardized screening for fibroids and blood pressure. Other "reasonable next steps," they believe, would be trials to determine whether more aggressive blood pressure control and/or early detection of hypertension could reduce the incidence of and complications associated with fibroids and whether shrinkage of fibroids, as seen with ultrasonography, occurs in women treated with antihypertensive medication compared with untreated women. Although the most effect therapies for fibroids remain surgical, the results of their study association suggest ways in which to explore novel approaches to the medical management of fibroids that could reduce associated morbidity and surgery, the Harvard researchers suggest.