Hormone Replacement Therapy Might Improve Outcomes for Women with Pulmonary Hypertension

Researchers estimate that about 1% of the global population has pulmonary hypertension which is a disease caused by high blood pressure in the blood vessels that deliver oxygen to the lungs. Past studies show that pulmonary hypertension is more common in females, for which there is currently no cure. 

Scientists believe the hormone estrogen may play an important role in pulmonary hypertension in females.742 female participants who had pulmonary hypertension were recruited in this study and were classified into five groups. Pulmonary hypertension is a progressive disease that can significantly impact one’s quality of life despite current treatments.  

Researchers examined the impact of both exogenous and endogenous hormone exposure on pulmonary hypertension. Since they wanted to explore the suspected hormonal impact, endogenous hormone exposure was defined as one’s lifetime duration of menses, and exogenous hormone exposure was defined as one ever having used hormone replacement therapy (HRT). 

They also wanted to assess whether there was a difference between pulmonary vascular disease, which is why they looked at pulmonary arterial pressure and pulmonary vascular resistance, which was measured by right heart catheterization and right ventricular function. 

Ultimately there was no statistically significant difference in lifetime duration of menses regarding pulmonary vascular disease, but researchers did observe improvement with right ventricular ejection fraction. Researchers found an association between the use of hormone replacement therapy and lower mean pulmonary artery pressure, higher right ventricular fractional shortening, and right ventricular ejection fraction. 

So far, their preliminary data has been positive with improvement in mean pulmonary arterial pressure, pulmonary vascular resistance, right ventricular ejection fraction, and right ventricular fractional shortening with the use of HRT in the pulmonary hypertension cohort. They did not observe a difference with the healthy controls or comparator, one with risk factors for pulmonary hypertension but does not have the disease with increased lifetime duration of menses or with the use of HRT. These findings were consistent with their hypothesis that suggests that hormones could be protective with this pulmonary hypertension subgroup. 

Additionally, those in the pulmonary hypertension Group 1 had lower mean pulmonary artery pressure, pulmonary vascular resistance, and higher right ventricular ejection fraction if exposed to HRT. Preliminary data suggests that these findings are most notable with Group 1 pulmonary hypertension compared to the other subgroups of pulmonary hypertension. Future research should focus on confirming this relationship between estrogen and improving pulmonary hypertension, preferably with randomized control trials.