Role of Hormone Replacement Therapy in Managing Pulmonary Hypertension for Women: Study

Researchers estimate that about 1% of the global population has pulmonary hypertension — a disease caused by high blood pressure in the blood vessels that deliver oxygen to the lungs.

Now, according to research presented at the ATS 2024 International Conference, the use of hormone replacement therapy (HRT) may be associated with improved pulmonary hypertension in women.

Hormone replacement therapy (HRT) may offer potential benefits for women with pulmonary hypertension. Estrogen, a key hormone in HRT, has been found to have vasodilatory effects, meaning it can help relax and widen blood vessels, improving blood flow and reducing the strain on the heart. Additionally, HRT may help address symptoms of menopause that can exacerbate the condition, such as fatigue and reduced exercise capacity.

In this study, researchers recruited 742 female participants and classified those with pulmonary hypertension into the five groups established by the World Symposium on Pulmonary Hypertension:

Group 1: Pulmonary arterial hypertension

Group 2: Pulmonary hypertension caused by left heart disease

Group 3: Pulmonary hypertension caused by lung disease

Group 4: Pulmonary hypertension from chronic blood clots in the lungs

Group 5: Pulmonary hypertension from unknown causes

The impact of both exogenous and endogenous hormone exposure on pulmonary hypertension across these groups were examined.

Upon analysis, researchers discovered that average pulmonary arterial pressure decreased with a greater lifetime duration of menstruation across all pulmonary hypertension groups. They also found that hormone replacement therapy (HRT) was associated with lower mean pulmonary artery pressure, higher right ventricular fractional shortening, and improved right ventricular ejection fraction.

Specifically, those in pulmonary hypertension Group 1 showed lower mean pulmonary artery pressure, reduced pulmonary vascular resistance, and higher right ventricular ejection fraction when exposed to HRT.

“Our preliminary data indicates that hormone replacement therapy (HRT) improves mean pulmonary arterial pressure, pulmonary vascular resistance, right ventricular ejection fraction, and right ventricular fractional shortening in women with pulmonary hypertension. No differences were observed in healthy controls or with increased lifetime duration of menses. These findings support the hypothesis that hormones may be protective, especially notable in Group 1 pulmonary hypertension. Further studies are needed to explore this,” said Audriana Hurbon, assistant clinical professor in the Department of Medicine at The University of Arizona College of Medicine Tucson and corresponding author of the study.

Reference: A. Hurbon, G.J. Beck, S.C. Erzurum, R.P. Frantz, G. Grunig, P.M. Hassoun, A. Hemnes, N. Hill, E. Horn, C. Jellis, B. Larive, J. Leopold, M. Park, E.B. Rosenzweig, F.P. Rischard, and PVDOMICS Study Group. The Impact of Reproductive History on Pulmonary Hypertension: Insights From the Pvdomics Study (abstract). Am J Respir Crit Care Med 2024;209:A2748.