Association of blood pressure variability with Endothelin-1 by menopause status among Black women: findings from the Jackson Heart Study

Abstract

Postmenopausal women have a higher risk of hypertension compared with premenopausal women possibly related to increased endothelial dysfunction in the setting of lower levels of circulating estrogen. Using data from 660 women in the Jackson Heart Study (JHS), postmenopausal women had higher daytime, nighttime and 24 h systolic blood pressure variability (BPV) compared with premenopausal women, and higher nighttime systolic BPV was associated with higher endothlin-1 (a marker of endothelial dysfunction) in postmenopausal women (ß = 0.27 [0.05, 0.50], p = 0.019), even after adjustment for possible confounders including age. These findings highlight the relevance of menopause status to blood pressure variability and the potential role of blood pressure variability in the development of high endothelin-1 in postmenopausal women.

FIGURE. Ambulatory Blood Pressure Monitoring, Endothelin-1 and Menopause Status in the Jackson Heart Study.

Panel A presents select characteristics in postmenopausal vs. premenopausal women as mean ±standard deviation, %, or median [25^th-75^th percentile]. Panel B presents the median [25^th-75^th percentile] for 24-hour, daytime and nighttime systolic and diastolic blood pressure by menopause status, p-values presented for each comparison using Wilcoxon rank sum tests. * indicates a significant difference (p<0.05) in average real variability (ARV) for each ambulatory blood pressure metric (e.g. 24-hour SBP ARV is significantly different in postmenopausal compared with premenopausal women). Panel C presents the association between daytime and nighttime SBP and DBP ARV with standardized endothelin-1 for postmenopausal women, the solid line represents the estimate and the shaded area presents the 95% confidence interval. Endothlin-1 is log transformed given a non-normal distribution. ARV: average real variability; BP: blood pressure; DBP: diastolic blood pressure; eGFR: estimated glomerular filtration rate, calculated using the 2021 CKD-EPI creatinine equation; SBP: systolic blood pressure.