Severe PMS May Indicate Early High Blood Pressure

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About one in 10 American women report moderate or severe symptoms of prementrual syndrome (PMS). A recent study published in the American Journal of Epidemiology supports the theory that women with relatively severe symptoms have an increased likelihood of developing high blood pressure and that hypertension risk is especially high in occurring earlier in life, before age 40.

The study, entitled "Premenstrual Syndrome and Subsequent Risk of Hypertension in a Prospective Study," was conducted by researchers from the University of Massachusetts/Amherst, School of Public Health, led by Elizabeth Bertone-Johnson, ScD, and colleagues.

In a prospective case-control format they studied 1,257 women with "clinically significant" (moderately severe or severe) PMS, manifested by mood swings, lethargy, sweats, food cravings and breast tenderness. They then compared them to 2,463 women with mild or no PMS symptoms. All the women were aged 27-40, and the data were collected via the Nurses Health Study II between 1991 and 2005. The study subjects were followed to detect the new incidence of hypertension, or HT, until 2011, meaning some were followed for 20 years, and all were followed for at least six years.

Among the women with significant PMS, 342 women (or 27 percent) reported being diagnosed with HT, and among those with mild/no PMS 541 (22 percent) also had HT. The increased risk of developing HT was approximately 40 percent for those with PMS. Focusing only on HT developing before age 40, the risk was 3.3 fold higher than among those without PMS.

All these results were controlled for known confounders, including BMI, smoking, age, alcohol intake, family history and other known HT-risk factors. Interestingly, neither the use of antidepressants nor hormonal therapies, both commonly used to ameliorate PMS symptoms, had any discernible effect on HT. However, intake of the B-vitamins riboflavin and thiamine did attenuate the increased risk.

Why PMS should have any link at all to HT is not clear. Theoretically, some common interaction between the renin-angiotensin-aldosterone hormonal system (which regulates fluid balance, sodium excretion, and blood pressure) and PMS symptoms is one possible mechanism.

"The prevalence of hypertension is increasing among younger women, and new strategies are needed to identify high-risk women who should be targets for early intervention," the authors concluded. "These results suggest that PMS might be associated with future development of hypertension and that this risk may be modifiable."

The level of vitamins B1 and B2 intake was obtained from food diaries, so even among nurses it may not be highly reliable. But if HT can be prevented to any significant degree by supplementing younger women's diets with those innocuous vitamins, it would be worth a prospective clinical study at least to find out.