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NEW ORLEANS -- Among midlife women, untreated and new-onset hypertension were associated with an increased risk of developing fibroids, while treated hypertension was linked to a lower risk, a prospective study showed.

In an analysis of more than 2,500 midlife women with no history of fibroids, those with untreated hypertension had an 18% greater risk of fibroid diagnosis compared with those without hypertension, and women with new-onset hypertension had a 45% greater risk, reported Susanna Mitro, PhD, a research scientist at Kaiser Permanente Northern California in Oakland, during a presentation at the American Society for Reproductive Medicine (ASRM) annual meeting.

On the other hand, women who were already using antihypertensive medication had a 37% lower risk, and if they were using an angiotensin-converting enzyme (ACE) inhibitor, the risk was 48% lower.

"These results suggest that blood pressure control could suggest an opportunity to prevent clinically apparent fibroid development in midlife, which is a high-risk time for fibroids to become clinically apparent," Mitro said.

She noted that by age 50, 70% to 80% of people who still have a uterus will have a fibroid.

"But despite this very common gynecologic morbidity, fibroid etiology is not completely understood," she added. "So if we can control blood pressure and prevent fibroid development as a result, that would be a win for treating fibroids, and second, it would offer some insight into fibroid etiology."

Prior research has indicated that the renin-angiotensin system (RAS) may impact fibroid development because the hormones work together to increase blood pressure, Mitro explained. ACE inhibitors interfere with the RAS pathway, so building on the ACE inhibitor findings seen here, which may offer insight into fibroid etiology, is one of Mitro's next steps.

, Steven L. Young, MD, PhD, president of the Society for Reproductive Endocrinology and Infertility, said that this research "assists us and our patients to better understand the full impact of uterine fibroids. It is well beyond just the reproductive system."

For this study, women ages 42 to 52 who had their uterus and at least one ovary and reported having a menstrual period in the 3 months prior were enrolled from the Study of Women's Health Across the Nation (SWAN) cohort. Fibroid history was reported at enrollment (1996 to 1997); women who had a history of fibroids at baseline were excluded.

Ultimately 2,570 participants were included and followed for 13 semi-annual follow-up visits -- one of which is still ongoing -- where they had their blood pressure taken and were asked about any fibroid diagnosis and use of any antihypertensive medicine. Discrete survival analysis tested the longitudinal association.

Women without high blood pressure were compared with those with untreated hypertension, treated and controlled hypertension, and treated with poorly controlled hypertension. In the cohort, 40% had measured hypertension, 18% had diagnosed hypertension, and 13% used antihypertensive medication.

Of these women, mean age was 45, 49% were white, 25% were Black, 17% were Asian (8% Chinese and 9% Japanese), and 9% were Hispanic. In addition, 26% had obesity, and 17% were nulliparous. A little over half of the women had not begun menopause (55%), while 45% were early perimenopausal.

Past research on this topic has been limited by self-reported blood pressure data, as well as insufficient data on race/ethnicity and body mass index, which are risk factors for fibroids.

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