The balance between estrogen and androgens plays a role in blood pressure (BP) regulation apart from the absolute hormone levels alone, according to new data from a review of 14 studies presented at the American Heart Association’s Hypertension Scientific Sessions (HYP) 2025.
The recognition of sex-based differences in BP regulation is increasing, but the role of sex hormones in hypertension remains underexplored, said lead author Vyom J. Patel, DO, internal medicine resident at Indiana University School of Medicine, Indianapolis, in an interview. “Our study aimed to systematically examine how hormonal status or treatment influences blood pressure, especially in populations undergoing major hormonal shifts like menopause or androgen suppression,” he said.
Patel and colleagues identified 14 studies, including four randomized controlled trials and 10 observational studies. The study populations included postmenopausal women, women with polycystic ovary syndrome (PCOS), and men receiving antiandrogen therapy.
Overall, women had generally lower BP than men prior to menopause; however, in postmenopausal women, decreased estrogen was associated with increased BP, as was PCOS.
Across the randomized controlled trials, estrogen replacement therapy was associated with a slight decrease in BP in women compared to that in men, whereas use of oral contraception was associated with a slight increase in BP.
In men, antiandrogen therapy was associated with a slight decrease in BP.
“We were somewhat surprised by the variability in outcomes across studies, especially the inconsistent effects of hormone therapy,” said Patel. “This underscores the complexity of hormonal pathways in cardiovascular regulation and highlights the need for more targeted research,” he said.
In practice, clinicians should consider sex and hormonal status when evaluating and treating hypertension, Patel said. “While hormone-based therapies show potential, their effects on blood pressure are modest and context-dependent, so treatment should be individualized,” he added.
The main limitations of the current study were the small number of high-quality randomized trials and the variability across study designs, Patel told Medscape Medical News. “Future research should focus on larger, well-controlled trials that explore specific hormone types, delivery methods, and patient subgroups to better understand who might benefit from hormonal interventions,” he said.
Looking Beyond Absolute Hormone Levels
Ongoing studies of the physiologic effects of sex hormones on cardiovascular health are essential for risk-factor modification, said Sabrina Islam, MD, MPH, associate professor of medicine in the cardiology section at the Lewis Katz School of Medicine at Temple University, Philadelphia, in an interview.
The current study is important because it examined several populations, including postmenopausal women, men receiving antiandrogen therapy, and women with increased androgen hormone expression, said Islam, who was not involved in the study.
The interplay between sex hormones was intriguing, Islam told Medscape Medical News. The study’s attention to the importance of the balance between the hormone levels in addition to the absolute hormone levels emphasized the role of hormonal regulation in the management of high BP, she said.
The study findings highlight the importance of taking sex hormone levels and interactions into account when managing BP, said Islam. “Higher estrogen levels and lower androgen levels appear to allow for lower blood pressure values, although the relationship and absolute levels at which these relationships are noted are inconsistent,” she said.
Further exploration of the relationship between sex hormone levels and BP may help increase the understanding of potential adverse interactions and the need for closer surveillance and may reveal potential therapies in hypertension management, Islam added.
The study received no outside funding. Patel and Islam had no financial conflicts to disclose.