Risk of hypertension after hysterectomy: a population-based study

BJOG. 2018 Dec;125(13):1717-1724. doi: 10.1111/1471-0528.15389. Epub 2018 Aug 6.


Objective: Hysterectomy is the second most common surgery performed mainly for benign uterine pathologies in females. The association between hysterectomy and the subsequent risk of hypertension remains controversial. This study investigated the risk of developing hypertension in women who had a hysterectomy.

Design: Population-based retrospective cohort study.

Setting: We used the Taiwan National Health Insurance Research Database with claims data of 1 million randomly selected insured individuals.

Population: Women with and without hysterectomy and bilateral salpingo-oophorectomy, aged 30-49 years, were identified in 2000-2013 from the insurance data.

Methods: From the claims data, we identified 6674 women with hysterectomy without hypertension at the time of the surgery. The comparison cohort were 26 696 women randomly selected from women without hysterectomy and hypertension, matched by age and the year hysterectomy was performed. Adjusted hazard ratio (aHR) of hypertension was estimated after controlling for comorbidities.

Main outcome measure: Prediction for hypertension following hysterectomy for benign disease.

Results: Both cohorts had a median age of 43.9 years. After a median follow up of 6.4 years, the incident hypertension was higher in the hysterectomy cohort than in the comparison cohort, with an adjusted hazard ratio (aHR) of 1.35 [95% confidence interval (CI) 1.27-1.44]. The incidence increased with age, with a higher aHR in hysterectomised women aged 40-49 years (aHR 1.37, 95% CI 1.06-1.83) than in those aged 30-39 years (aHR 1.22, 95% CI 1.02-1.46).

Conclusion: Findings in this study suggest that women with hysterectomy are more likely to be diagnosed with hypertension in the follow-up period.

Tweetable abstract: Women with hysterectomy before 50 years of age are at an increased risk of developing subsequent hypertension.

Plain language summary: Hysterectomy is one of the most common surgeries for women with benign uterine disease. Hysterectomy may lead to a sudden decline in the production of sex hormone (estrogen and progesterone), which is responsible for vessel wall endothelial dysfunction leading to hardening of arteries and subsequent hypertension. However, the association between hysterectomy and risk of hypertension remains controversial. This study investigated whether premenopausal women have an elevated risk of hypertension after hysterectomy. This study employed the Taiwan National Health Insurance Research Database to identify 6674 women 30-49 years old who had a hysterectomy between 2000 and 2013, and a comparison group of 26 696 women who did not have a hysterectomy matched by age. Women in both the groups had no hypertension at baseline (recruiting date or within 1 year after recruiting date). By the end of 2013, we found that 1196 (17.9%) and 3613 (13.5%) women had developed hypertension in the hysterectomy and the comparison groups, respectively. The hypertension incidence was 1.4-fold greater in the hysterectomy group than in the control group (27.8 versus 20.2/1000 person-years).

Keywords: Cardiovascular disease; coronary heart disease; hypertension; hysterectomy; nationwide cohort.

MeSH terms

  • Adult
  • Age Factors
  • Case-Control Studies
  • Female
  • Humans
  • Hypertension / epidemiology*
  • Hysterectomy / statistics & numerical data*
  • Incidence
  • Middle Aged
  • Retrospective Studies
  • Risk Factors
  • Taiwan / epidemiology