The effect of hypertension and anti-hypertensive drugs on endometrial thickness and pathology

ObjectivesWe sought to clarify if hypertension has a direct effect on endometrial pathology. Furthermore, we wanted to evaluate the effect of possible differences among the various antihypertensive drugs on the clinico-pathological findings.Patients and methodsThe records of 228 patients who underwent D&C at our tertiary cancer hospital were examined. All other aetiopathogenic factors (DM, tamoxifen, obesity, etc.) for endometrial pathology were excluded, as well as endometrial carcinoma cases. We compared the differences in the clinical symptoms and signs between hypertensive and normotensive women, as well as differences in their histological findings. Furthermore, we carried out a subgroup analysis of the above with respect to the antihypertensive agent(s) the patients used.ResultsOne hundred and twenty-three patients (54%) were hypertensive and 105 (46%) were normotensive. Vaginal spotting was present in approximately 75% of patients in both groups, but sonographic endometrial thickening was significantly more prevalent among hypertensive women (52.8% versus 34.3%, p = 0.004). Hyperplasia was the commonest positive histological finding among hypertensive women (44.7%), compared with polyps for the normotensives. Furthermore, atypia was censored in 4.1% of hypertensive patients only. The subgroup analysis with respect to the various antihypertensives was similar to the above histological distribution, with the exception of the combination b-blocker plus calcium antagonist, which had a significantly more favourable histological profile with over 60% normal endometria.ConclusionsHypertensive patients tend to require D&C more frequently. Sonographic endometrial thickening is significantly more frequent among them. Hyperplasia with or without atypia occurs in approximately 50% of hypertensive women. No differences in the above were justified depending on the different antihypertensive agents used, with the exception of the b-blocker plus calcium antagonist (±ACE inhibitor) combination, which requires further evaluation.