Sex Hormones Shape Blood Pressure Regulation in Hypertension
New evidence links hormonal balance to cardiovascular health across men and women
Topline
A review of 14 studies presented at the American Heart Association’s Hypertension Scientific Sessions 2025 found that the balance between estrogen and androgens, not just their absolute levels, plays a critical role in regulating blood pressure. Postmenopausal women, women with polycystic ovary syndrome (PCOS), and men on antiandrogen therapy showed distinct patterns, suggesting hormone status should be factored into hypertension care.
Study Details
Researchers from Indiana University School of Medicine analyzed 14 studies, including four randomized controlled trials and ten observational studies. Study populations included postmenopausal women, women with PCOS, and men undergoing antiandrogen therapy.
The aim was to understand how hormonal status and interventions influence blood pressure regulation.
Methodology
The team conducted a systematic review of published data. Study types ranged from randomized trials to real-world observational cohorts. Blood pressure differences were assessed across groups with hormonal changes, such as menopause or medical hormone suppression, to identify consistent trends.
Key Findings
Pre-menopause vs. post-menopause: Women generally had lower blood pressure than men prior to menopause. Postmenopausal women experienced increased blood pressure with declining estrogen.
PCOS: Women with higher androgen levels had elevated blood pressure.
Hormone therapy: Estrogen replacement was linked to slight blood pressure reductions, while oral contraceptives caused mild increases.
Men on antiandrogen therapy: Showed small reductions in blood pressure.
Variability: Results were not always consistent, highlighting the complexity of hormonal pathways in cardiovascular regulation.
Implications for Practice
The findings suggest clinicians should consider sex and hormonal status when evaluating and treating hypertension.
For patients, understanding that blood pressure regulation is not only about lifestyle and medication but also about hormone balance may improve personalized care. Hormone-based therapies may provide modest benefits but must be tailored to the individual’s context.
Future research is needed to identify which hormone types, delivery methods, and patient groups may benefit most from targeted interventions.