What is hypertension?
Hypertension is high blood pressure – when the pressure in your blood vessels is too high.
Blood pressure is measured in two numbers. The higher number is called the systolic pressure and shows the force at which your heart is pumping blood around your body. The lower number is called the diastolic pressure and shows the resistance to the blood flow in your blood vessels when the heart is relaxed.
For blood to flow effectively around the body, you need a minimum blood pressure. Having a blood pressure that is very low can cause health problems, like fainting, confusion, headache, tiredness, and kidney injury. This is called hypotension.
Having a blood pressure that is very high can result in injury to the walls of the blood vessels, which can also cause health problems. This is called hypertension.
Hypertension itself usually has no symptoms, but it is associated with increased risks of health problems. These include cardiovascular disease, heart failure, stroke, aneurysms, kidney disease, peripheral vascular disease.
How is hypertension diagnosed?
The healthy range for blood pressure is considered to be between 90/60mmHg and 120/80mmHg. Hypertension is diagnosed if the blood pressure is greater than 140/90mmHg.
What causes hypertension?
Hypertension usually doesn't have a single cause, but multiple interacting causal factors. These can be smoking, excessive alcohol consumption, stimulant drugs including caffeine, stress, inactivity, being overweight, and consuming too much salt. The risk of hypertension is increased by ageing, family history of hypertension, and being a member of a socially disadvantaged group.
How is hypertension treated?
Hypertension can be treated with lifestyle changes and blood pressure medication.
Lifestyle changes address the risk factors that may be relevant to you. This includes stopping smoking, exercising regularly, maintaining a healthy weight, decreasing alcohol, caffeine, and salt consumption.
Antihypertensive medications include ACE inhibitors (enalapril, lisinopril), angiotensin receptor antagonists (candesartan, losartan), calcium channel blockers (amlodipine, diltiazem), diuretics (bendroflumethiazide, amiloride), beta blockers (bisoprolol, atenolol), and alpha blockers (doxazosin).
What evidence is there on hypertension in the transgender community?
Research suggests that transgender people suffer from worse cardiovascular health than cisgender people. Transgender people are a marginalised group who suffer various social harms, including prejudice, stigmatisation, exclusion, and rejection. These stressors have psychological, behavioural, and physiological effects, which may have a negative impact on cardiovascular health, including increased blood pressure (Streed et al., 2021).
Can hormones affect blood pressure?
Hormones can influence blood pressure. Testosterone tends to increase blood pressure, and oestrogen tends to decrease blood pressure. This is part of the reason blood pressure of cisgender men is usually higher than the blood pressure of cisgender women, although other factors could contribute to this difference.
In a recent study, testosterone treatment in transgender men was associated with a 2.6mmHg increase in average systolic pressure. Oestrogen treatment in transgender women was associated with a 4.0mmHg decrease in average systolic pressure. This suggests that gender affirming hormone treatment moved the blood pressures of transgender men and women into the ranges expected for men and women respectively.
What are the implications for gender affirming hormone treatment?
Hypertension does not prevent you from receiving gender affirming hormone treatment. If you are receiving gender affirming hormone treatment and have hypertension, it's best to treat your hypertension and to address any cardiovascular risk, not to change your gender affirming hormone treatment.
While hormones do influence blood pressure, gender affirming hormone treatment does not cause hypertension. Rather, it changes your physiological profile so that your blood pressure moves closer to the range expected for your gender.
Transgender people do have higher risks of hypertension and cardiovascular disease for other reasons unrelated to hormones. We recommend having regular health checks to monitor you blood pressure.
References
Banks, K., Kyinn, M., Leemaqz, S. Y., Sarkodie, E.,Goldstein, D., Irwig, M. S. (2021). “Blood Pressure Effects of Gender-Affirming Hormone Therapy in Transgender and Gender-Diverse Adults”. Hypertension, 77 (6): 2066–2074.
Streed, C. G. Jr, Beach, L. B., Caceres, B. A., Dowshen, N. L., Moreau, K. L., Mukherjee, M., Poteat, T., Radix, A., Reisner, S. L., and Singh, V. (2021). “Assessing and Addressing Cardiovascular Health in People Who Are Transgender and Gender Diverse: A Scientific Statement from the American Heart Association. Circulation”. 144 (6): e136–e148.