# Aldosterone and the menopausal transition's increase in blood pressure and cardiovascular risk

> **NIH NIH R01** · UNIVERSITY OF MICHIGAN AT ANN ARBOR · 2024 · $770,042

## Abstract

There is more female hypertension-related mortality than male. Although women’s blood pressure is lower than
men’s in younger life, after menopause the reverse is true. A decrease in estrogen plays a role in women’s
midlife increase in blood pressure. However, factors that modify the extent of this increase in individuals are
not known.
The renin-angiotensin-aldosterone system (RAAS) is crucial to blood pressure regulation, and it is also the
target of many antihypertensive medications. These different medications vary in their effects, depending on
where in the RAAS they act. Angiotensin-converting enzyme inhibitors (ACEis) and angiotensin-receptor
blockers (ARBs) do not reliably prevent the production of aldosterone, which can “break through” these
treatments, worsening outcomes.
We propose to study changes in serum aldosterone levels in 1,534 women participating in a large, longitudinal
study of women’s midlife health, the Study of Women’s Heath Across the Nation (SWAN). These
measurements will be made in sera collected 5±1 years prior to the final menstrual period (FMP), within a year
of the FMP, and 5±1 years after the FMP. In addition, since renin measurements can help provide context to
aldosterone measurements, we will also measure plasma renin concentration when matching plasma samples
are available.
The broad, long-term objective of the project is to improve cardiovascular health in midlife and older women.
The project has 3 Specific Aims.
Aim 1 is to identify the effect of the menopausal transition on the relationship between aldosterone and
changes in blood pressure. We will leverage the SWAN study to identify how high serum aldosterone
concentration is associated with time-averaged blood pressure during the menopausal transition.
Aim 2 is to identify the impact of aldosterone breakthrough on blood pressure outcomes across the
menopausal transition. We will identify women whose initial (FMP -5 years) aldosterone measurement is in the
absence of an ACEi or ARB and in whom a subsequent aldosterone measurement was under treatment with
one of these drugs. We will identify the impact of aldosterone breakthrough on systolic blood pressure.
Aim 3 is to identify the effect of changes in aldosterone during the menopausal transition on long-term renal
and cardiovascular outcomes. We will identify the relationship between serum aldosterone concentration and
subsequent incident cardiovascular events.
When our study is complete, we will disseminate for the first time an understanding of the changes in
aldosterone and renin during menopause, medication effects on these hormones, and the influence of these
hormones on cardiovascular outcomes.

## Key facts

- **NIH application ID:** 10879910
- **Project number:** 1R01HL164678-01A1
- **Recipient organization:** UNIVERSITY OF MICHIGAN AT ANN ARBOR
- **Principal Investigator:** James Brian Byrd
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $770,042
- **Award type:** 1
- **Project period:** 2024-05-20 → 2029-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10879910

## Citation

> US National Institutes of Health, RePORTER application 10879910, Aldosterone and the menopausal transition's increase in blood pressure and cardiovascular risk (1R01HL164678-01A1). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10879910. Licensed CC0.

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