Happy October! It’s spooky season, and I can’t think of anything more fitting to talk about than our heart and blood pressure this month. To me, it’s truly fascinating how the mechanisms, feedback loops, and communication that occur in our bodies as they attempt to maintain balance (otherwise known as homeostasis). Part of this balance includes regulating blood pressure. Hormones play a crucial role in the intricate web of regulating bodily functions, including our blood pressure. The relationship between hormones and blood pressure is complex, and although I would like to say it is well understood, I believe there is still much more to learn about how optimal hormone levels contribute to healthy blood pressure. Let’s explore each hormone and its impact on blood pressure.
Estrogen: I believe it is fair to say that, of all the hormones, we are generally most aware of the benefits of estrogen in heart health. We know that, prior to menopause, a woman’s risk of cardiovascular disease is significantly lower compared to their male counterparts. However, when women go through menopause, their cardiovascular risk skyrockets, attributed to the loss of estrogen. Estrogen plays a role in vasodilation, keeping our blood vessels open, which, in turn, decreases the force needed to circulate blood and lowers blood pressure. Estrogen also helps maintain lower levels of cholesterol and reduces plaque formation in the blood vessels. When cholesterol levels are high and plaque forms within the blood vessels, it narrows the vessel diameter. You can imagine how this affects blood pressure. The narrower the tube, the more force is needed to push the blood through, leading to increased blood pressure.
Progesterone: The yin to Estrogen’s Yang. One of my biggest pet peeves is how little acknowledgment progesterone gets aside from its role in protecting women from endometrial cancer. Progesterone is much more than just uterine protection, and I think you’ll agree once we delve into its role in maintaining healthy blood pressure. Research by Barbagallo et al. (2001) on the vascular effects of progesterone demonstrated that progesterone has a direct effect on blood pressure. The results of their research showed that progesterone impacted blood pressure by dilating or opening blood vessels and blocking the uptake of calcium, like the action of calcium channel blockers, a class of blood pressure-lowering medications. Progesterone acts as a diuretic, helping reduce fluid retention and, subsequently, lowering blood pressure. Notably, Dr. Lawrence M. Resnick, Professor of Medicine at the Hypertension Center of Weill Cornell, one of the senior authors of the study (2001), emphasized the difference between synthetic progestins and natural progesterone in achieving blood pressure-lowering benefits. Another well-documented example of the impact of progesterone on blood pressure is in pregnancy. Progesterone relaxes smooth muscles, reducing resistance and the force required to circulate blood through the vessels. Interestingly, this effect peaks around 24 weeks and slowly returns to pre-pregnancy levels.
Testosterone: Age-related decline in testosterone is associated with cardiovascular disease and hypertension. One proposed mechanism is the aromatization or conversion of testosterone into 17-Beta Estradiol, known for its cardioprotective properties (2). In men with low testosterone levels, supplementing with testosterone improved lipid levels, decreased visceral fat, and had cardioprotective effects, including improvements in blood pressure (3). The reason testosterone and hypertension remain controversial may be due to anabolic steroids. It is well documented that the use of anabolic steroids has the opposite effect on lipid levels, blood pressure, and cardiovascular risk. This practice is often coupled with estrogen blockers, further eliminating the cardiovascular benefits of testosterone. This is in direct contrast to the clinical benefits observed when testosterone levels are optimal in both men and women, which includes improvements in the cardiovascular profile.
DHEA: What we know about DHEA is that levels decrease with age and that DHEA serves as a precursor or building block for our other sex hormones. However, less is known about the role of DHEA in blood pressure regulation. A randomized controlled trial by Weiss et al. (2012) found that DHEA replacement in older adults improved metrics of arterial stiffness, theoretically improving cardiovascular risk and reducing the force required to circulate blood flow. There is also research showing an association between lower baseline DHEA levels and hypertension. Further research needs to be done to truly understand the role of DHEA in hypertension.
Blood pressure and its influence are complex and multifactorial. Hormones are just one piece of the intricate puzzle. As I always say, addressing high blood pressure requires a focus on the pillars of wellness: Movement, Sleep, Nutrition, Mental Wellness, and Hormones. No pillar is more important than another; it’s about working towards a balance. And, of course, if you want to explore the role of hormone optimization in your health and wellness, you can follow my Instagram page @hormone_optimization or book a complimentary consultation with me to review whether hormone optimization is right for you. 😊
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