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Does hormone therapy affect blood pressure changes in the Diabetes Prevention Program?

Kim, Catherine MD, MPH1; Golden, Sherita H. MD, MHS2; Kong, Shengchun MS3; Nan, Bin PhD3; Mather, Kieren J. MD4; Barrett-Connor, Elizabeth MD5Diabetes Prevention Program Research Group

doi: 10.1097/GME.0b013e3182a0e3ea
Original Articles

Objective This study aims to examine whether blood pressure reductions differ by estrogen use among overweight glucose-intolerant women.

Methods We conducted a secondary analysis of Diabetes Prevention Program postmenopausal participants who used oral estrogen with or without progestogen at baseline and 1-year follow-up (n = 324) versus those who did not use oral estrogen with or without progestogen at either time point (n = 382). Changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP) were examined by randomization arm (intensive lifestyle change [ILS], metformin 850 mg twice daily, or placebo). Associations between changes in blood pressure and changes in sex hormone–binding globulin, estradiol, testosterone, and dehydroepiandrosterone were also examined.

Results Estrogen users and nonusers had similar prevalences of baseline hypertension (33% vs 34%, P = 0.82) and use of blood pressure medications at baseline (P = 0.25) and on follow-up (P = 0.10). Estrogen users and nonusers randomized to ILS had similar decreases in SBP (−3.3 vs −4.7 mm Hg, P = 0.45) and DBP (−3.1 vs −4.7 mm Hg, P = 0.16). Among estrogen users, women randomized to ILS had significant declines in SBP (P = 0.016) and DBP (P = 0.009) versus placebo. Among nonusers, women randomized to ILS had significant declines in DBP (P = 0.001) versus placebo, but declines in SBP were not significant (P = 0.11). Metformin was not associated with blood pressure reductions versus placebo regardless of estrogen therapy. Blood pressure changes were not associated with changes in sex hormones regardless of estrogen therapy.

Conclusions Among overweight women with dysglycemia, the magnitude of blood pressure reductions after ILS is unrelated to postmenopausal estrogen use.

Supplemental digital content is available in the text.

From the 1Department of Medicine and Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI; 2Department of Medicine, Johns Hopkins University, Baltimore, MD; 3Department of Biostatistics, University of Michigan, Ann Arbor, MI; 4Department of Medicine, Indiana University, Indianapolis, IN; and 5Department of Preventive Medicine, University of California San Diego, La Jolla, CA.

Received May 8, 2013; revised and accepted June 12, 2013.

Funding/support: The project described was supported by awards U01DK048489, R01DK083297, and K23DK071552 from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK provided funding to clinical centers and to the coordinating center for the design and conduct of the study, and for collection, management, analysis, and interpretation of data for the Diabetes Prevention Program. The Southwestern American Indian Centers were directly supported by the NIDDK and the Indian Health Service. The General Clinical Research Center Program of the National Center for Research Resources supported data collection in many of the clinical centers. Funding for data collection and participant support was also provided by the National Institute of Child Health and Human Development, the National Institute on Aging, the Office of Research on Women’s Health, the Office of Research on Minority Health, the Centers for Disease Control and Prevention, and the American Diabetes Association. Bristol-Myers Squibb and Parke-Davis provided medications. This research was also supported, in part, by the intramural research program of the NIDDK. LifeScan Inc, Health O Meter, Hoechst Marion Roussel Inc, Merck-Medco Managed Care Inc, Merck and Co, Nike Sports Marketing, Slim Fast Foods Co, and Quaker Oats Co donated materials, equipment, or medicines for concomitant conditions. McKesson BioServices Corp, Matthews Media Group Inc, and the Henry M. Jackson Foundation provided support services under subcontract with the coordinating center. The opinions expressed in this article are those of the investigators and do not necessarily reflect the views of the Indian Health Service or other funding agencies.

Financial disclosure/conflicts of interest: None reported.

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Address correspondence to: Catherine Kim, MD, MPH, Room 430W, Building 16, 2800 Plymouth Road, Ann Arbor, MI 48109-2800. E-mail:

© 2014 by The North American Menopause Society.