Study finds antihypertensive treatment reduces uterine fibroids risk

The risk of fibroid diagnosis is increased among patients with untreated and new-onset hypertension compared to those taking antihypertensive treatment, according to a recent study published in JAMA Network Open.

Seventy percent to 80% of people with uteruses experience uterine fibroids by the age of 50 years, with approximately half of fibroid cases being clinically relevant. Debilitating symptoms such as pain and bleeding may occur in patients with fibroids, but a standard prevention strategy has not been established.

While data has indicated a potential link between hypertension and other cardiovascular risk factors with fibroids, most of this data has come from cross-sectional studies. Data from prospective studies has remained limited.

To evaluate the associations between hypertension, cardiovascular risk factors, and fibroids, investigators conducted a multisite cohort study. Participants included patients aged 42 to 52 years with a menstrual period in the 3 months before enrollment who were not using hormones, pregnant, or lactating, and had a uterus and at least 1 ovary.

The baseline visit occurred between 1996 and 1997, and uterine fibroid diagnosis was confirmed during this time. Between 1998 and 2008, follow-up visits 1 through 11 occurred, with patients attending 1 visit annually. Finally, visit 12 occurred between 2010 and 2011.

Patients were asked about their fibroid diagnosis status at baseline, then asked if they presented with fibroids since the last visit at each follow-up visit. Exclusion criteria included fibroid history at enrollment and missing baseline fibroid status.

A standardized protocol was utilized to measure blood pressure during study visits. This included 2 readings from the right arm following 5 minutes of rest by the participant. Hypertension was defined as systolic blood pressure 130 mm Hg or higher or diastolic blood pressure 80 mm Hg or higher.

Blood-based biomarkers of cardiovascular disease risk included high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, total cholesterol, high-sensitivity C-reactive protein (hsCRP), and triglycerides in fasting blood samples.

Hypertension treatment was divided into 3 categories, including no antihypertensive treatment and measured normotension, no antihypertensive treatment and measured hypertension, and antihypertensive treatment. These treatments were provided to the reference group, untreated hypertension group, and treated hypertension group, respectively.

Hypertension status was also divided into 3 categories, including having never reported antihypertensive use or measured hypertension, having reported antihypertensive use or measured hypertension at a past visit, and having reported antihypertensive use or measured hypertension at the current visit.

Participants were considered to be using antihypertensive medication if they reported use in a current or prior visit. Covariates included age, race and ethnicity, educational attainment, parity, and smoking status.

There were 2570 participants included in the final analysis, aged a median 45 years. Of participants, 25.1% were Black, 8.3% Chinese, 9.1% Hispanic, 8.7% Japanese, and 48.9% White. A college education or greater was reported in 42.1% and premenopausal status 54.8%.

While continuous blood pressure was not associated with new reported fibroid diagnosis, the risk of new reported fibroid diagnosis was increased 45% among patients with new-onset hypertension vs never hypertensive patients. Notably, this increase in risk was not observed among patients with preexisting hypertension.

The risk of new fibroid diagnosis was increased 19% among patients with untreated hypertension vs those with no hypertension. However, the risk was reduced 20% among patients with treated hypertension.

Among patients eligible for antihypertensive treatment, a 37% reduced risk of new reported fibroid diagnosis was reported among use utilizing treatment. No association was reported between anthropometry, lipids, and hsCRP with new reported fibroid diagnosis risk.

These results indicated increased risk of newly reported uterine fibroids among midlife patients with untreated and new-onset hypertension, vs decreased risk among those with treated hypertension. Investigators concluded antihypertensive medication use may reduce fibroid development among this population.

Reference

Mitro SD, Wise LA, Waetjen LE, et al. Hypertension, cardiovascular risk factors, and uterine fibroid diagnosis in midlife. JAMA Netw Open. 2024;7(4):e246832. doi:10.1001/jamanetworkopen.2024.6832