Inverse association between total testosterone concentrations, incident hypertension and blood pressure

Background. Studies on the relationship between testosterone concentrations and blood pressure have yielded inconsistent results. Therefore, this study investigated the prospective association of total testosterone (TT) concentrations with risk of incident hypertension and blood pressure change in 1484 men aged 20–79 years. Methods. Data from the population-based Study of Health in Pomerania, Germany, were used. Serum TT concentrations, measured by chemiluminescent enzyme immunoassays, were categorised into age-specific quartiles. Generalised Estimating Equation (GEE) models, adjusted for age, waist circumference, physical activity, smoking and alcohol consumption were specified. Results. During a median follow-up time of 5.0 years, the prevalence of hypertension increased from 50.6% to 57.1%. TT concentrations were significantly lower in men with baseline and incident hypertension. Analyses revealed that men with baseline TT concentrations in the lowest quartile had an increased risk of incident hypertension (odds ratio (OR), 1.19 (95% CI, 1.10–1.28)) compared to men with higher TT concentrations. Furthermore, we found a significant inverse association of TT concentrations and blood pressure, showing that men with baseline TT concentrations in the lowest quartile showed the slightest change in systolic blood pressure (−6.01 mmHg), diastolic blood pressure (−2.11 mmHg) and pulse pressure (−3.98 mmHg). Sensitivity analyses in a subpopulation of men without antihypertensive medication confirmed these findings. Conclusion. These results show that low male TT concentrations are predictive of hypertension, suggesting TT as a potential biomarker of increased cardiovascular risk.

[1]  Jeroen J. Bax,et al.  2007 ESH-ESC Guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). , 2007, Blood pressure.

[2]  W. Rathmann,et al.  Cohort profile: the study of health in Pomerania. , 2011, International journal of epidemiology.

[3]  H. Völzke,et al.  Prospective association of low total testosterone concentrations with an adverse lipid profile and increased incident dyslipidemia , 2011, European journal of cardiovascular prevention and rehabilitation : official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology.

[4]  H. Völzke,et al.  Prevalence, incidence and risk factors of testosterone deficiency in a population-based cohort of men: results from the study of health in Pomerania , 2010, The aging male : the official journal of the International Society for the Study of the Aging Male.

[5]  U. John,et al.  Subclinical hyperthyroidism and blood pressure in a population-based prospective cohort study. , 2009, European journal of endocrinology.

[6]  A. Traish,et al.  The dark side of testosterone deficiency: III. Cardiovascular disease. , 2009, Journal of andrology.

[7]  G. Brabant,et al.  Associations of anthropometric parameters with serum TSH, prolactin, IGF-I, and testosterone levels: results of the study of health in Pomerania (SHIP). , 2009, Experimental and clinical endocrinology & diabetes : official journal, German Society of Endocrinology [and] German Diabetes Association.

[8]  H. Völzke,et al.  Prediction of Metabolic Syndrome by Low Serum Testosterone Levels in Men , 2009, Diabetes.

[9]  H. Völzke,et al.  Reference ranges for serum dehydroepiandrosterone sulfate and testosterone in adult men. , 2008, Journal of andrology.

[10]  J. Mckinlay,et al.  Inverse association of testosterone and the metabolic syndrome in men is consistent across race and ethnic groups. , 2008, The Journal of clinical endocrinology and metabolism.

[11]  A. Dobs,et al.  Testosterone making an entry into the cardiometabolic world. , 2007, Circulation.

[12]  M. Dowsett,et al.  Endogenous Testosterone and Mortality Due to All Causes, Cardiovascular Disease, and Cancer in Men: European Prospective Investigation Into Cancer in Norfolk (EPIC-Norfolk) Prospective Population Study , 2007, Circulation.

[13]  E. Nieschlag,et al.  Androgen receptor gene CAG repeat length and body mass index modulate the safety of long-term intramuscular testosterone undecanoate therapy in hypogonadal men. , 2007, The Journal of clinical endocrinology and metabolism.

[14]  A. Dominiczak,et al.  2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) , 2007, European heart journal.

[15]  Piotr Ponikowski,et al.  2007 Guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). , 2007, European heart journal.

[16]  T. Travison,et al.  The relative contributions of aging, health, and lifestyle factors to serum testosterone decline in men. , 2007, The Journal of clinical endocrinology and metabolism.

[17]  R. Jones,et al.  Selective inhibition of L-type Ca2+ channels in A7r5 cells by physiological levels of testosterone. , 2006, Endocrinology.

[18]  J. Lüdemann,et al.  Regional disparities of hypertension prevalence and management within Germany , 2006, Journal of hypertension.

[19]  E. Metter,et al.  Relationship between androgenic hormones and arterial stiffness, based on longitudinal hormone measurements. , 2006, American journal of physiology. Endocrinology and metabolism.

[20]  U. John,et al.  Laboratory markers carbohydrate-deficient transferrin, gamma-glutamyltransferase, and mean corpuscular volume are not useful as screening tools for high-risk drinking in the general population: results from the Study of Health in Pomerania (SHIP). , 2004, Alcoholism, clinical and experimental research.

[21]  C. Peers,et al.  Testosterone is a potent inhibitor of L-type Ca(2+) channels. , 2004, Biochemical and biophysical research communications.

[22]  R. Khalil,et al.  Gender, sex hormones, and vascular tone. , 2004, American journal of physiology. Regulatory, integrative and comparative physiology.

[23]  C. Bulpitt,et al.  Systolic blood pressure variability as a risk factor for stroke and cardiovascular mortality in the elderly hypertensive population , 2003, Journal of hypertension.

[24]  Daniel W. Jones,et al.  Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. , 2003, Hypertension.

[25]  D. Grobbee,et al.  Grobbee Endogenous Sex Hormones and Cardiovascular Disease in Men Society , 2003 .

[26]  W. Fraser,et al.  Diurnal rhythms of serum total, free and bioavailable testosterone and of SHBG in middle‐aged men compared with those in young men , 2003, Clinical endocrinology.

[27]  David Handelsman,et al.  Androgens and cardiovascular disease. , 2003, Endocrine reviews.

[28]  Daniel W. Jones,et al.  The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. , 2003, JAMA.

[29]  A. von Eckardstein,et al.  Androgens and coronary artery disease. , 2003, Endocrine reviews.

[30]  R. Collins,et al.  Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies , 2002, The Lancet.

[31]  Majid Ezzati,et al.  For Personal Use. Only Reproduce with Permission from the Lancet Publishing Group , 2022 .

[32]  S. Oparil,et al.  Sex hormones and hypertension. , 2002, Cardiovascular research.

[33]  C. Hayward,et al.  Effects of testosterone on coronary vasomotor regulation in men with coronary heart disease. , 1999, Circulation.

[34]  A. Kriska,et al.  Longitudinal relation between endogenous testosterone and cardiovascular disease risk factors in middle-aged men. A 13-year follow-up of former Multiple Risk Factor Intervention Trial participants. , 1997, American journal of epidemiology.

[35]  H. Turner,et al.  Gonadal function in men with chronic illness , 1997, Clinical endocrinology.

[36]  R. Francis,et al.  Androgen supplementation in eugonadal men with osteoporosis-effects of 6 months of treatment on bone mineral density and cardiovascular risk factors. , 1996, Bone.

[37]  L. Bang,et al.  24-h ambulatory blood pressure in 352 normal Danish subjects, related to age and gender. , 1995, American journal of hypertension.

[38]  J. Vestbo,et al.  Isolated systolic hypertension as a major risk factor for stroke and myocardial infarction and an unexploited source of cardiovascular prevention: a prospective population-based study. , 1995, Journal of human hypertension.

[39]  J. Yarnell,et al.  Endogenous sex hormones and ischemic heart disease in men. The Caerphilly prospective study. , 1993, Arteriosclerosis and thrombosis : a journal of vascular biology.

[40]  A. Vermeulen,et al.  Representativeness of a single point plasma testosterone level for the long term hormonal milieu in men. , 1992, The Journal of clinical endocrinology and metabolism.

[41]  E. Barrett-Connor,et al.  Endogenous sex hormones and cardiovascular disease in men. A prospective population-based study. , 1988, Circulation.

[42]  E. Barrett-Connor,et al.  Blood pressure and endogenous testosterone in men: an inverse relationship. , 1988, Journal of hypertension.

[43]  S. Zeger,et al.  Longitudinal data analysis using generalized linear models , 1986 .

[44]  L. Kuller,et al.  Relation between plasma high-density lipoprotein cholesterol and sex hormone concentrations in men. , 1984, The American journal of cardiology.

[45]  F. Gyntelberg,et al.  Coronary risk factors and plasma sex hormones. , 1982, The American journal of medicine.

[46]  G. Balercia,et al.  Pulse pressure, an index of arterial stiffness, is associated with androgen deficiency and impaired penile blood flow in men with ED. , 2009, The journal of sexual medicine.

[47]  E. Barrett-Connor,et al.  Low serum testosterone and mortality in older men. , 2008, The Journal of clinical endocrinology and metabolism.

[48]  E. Barrett-Connor,et al.  Association of endogenous testosterone with blood pressure and left ventricular mass in men. The Tromsø Study. , 2004, European journal of endocrinology.