Effects of hormonal replacement therapy in postmenopausal hypertensive patients

Affinito, P.; Palomba, Stefano; Bonifacio, Marika; Fontana, Dario; Izzo, Raffaele; Trimarco, Bruno; Nappi, Carmine

doi:10.1016/s0378-5122(01)00196-7

Cited by 44 publications

(23 citation statements)

References 19 publications

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“…Overall, pooled analysis of randomized placebo-controlled studies indicated that clinic BPs were unchanged whereas 24-hour ambulatory BPs were reduced by 4-5/2-3 mm Hg with transdermal estradiol (Table 2) [19,31,38,[64][65][66][67][68][69][70]. This reduction in ambulatory BP was seen in both normotensive [31,38,69] and hypertensive women [66].…”

Section: Effects Of Estrogen On Blood Pressure In Postmenopausal Womenmentioning

confidence: 96%

Estrogen and hypertension

Ashraf

Vongpatanasin²

2006

Current Science Inc

137

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Menopause is accompanied by a dramatic rise in the prevalence of hypertension in women, suggesting a protective role of endogenous estradiol on blood pressure (BP). Both animal experimental and human clinical investigations suggest that estrogen engages several mechanisms that protect against hypertension, such as activation of the vasodilator pathway mediated by nitric oxide and prostacyclin and inhibition of the vasoconstrictor pathway mediated by the sympathetic nervous system and angiotensin. However, emerging evidence from recent clinical trials indicates a small increase, rather than decrease, in systolic BP with oral estrogen administration in postmenopausal women, without any detectable effect on diastolic BP. Mechanisms underlying this selective rise in systolic BP in postmenopausal women and oral contraceptive-induced hypertension in premenopausal women remain unknown, but the rise may be related to supraphysiologic concentration of estrogen in the liver. To date, transdermal delivery of estrogen, which avoids the first-pass hepatic metabolism of estradiol, appears to have a small BP-lowering effect in postmenopausal women and may be a safer alternative in hypertensive women.

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Section: Effects Of Estrogen On Blood Pressure In Postmenopausal Womenmentioning

confidence: 96%

Estrogen and hypertension

Ashraf

Vongpatanasin²

2006

Current Science Inc

137

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“…Combined with transdermal NETA, none of the five studies found a significant change. Combined with an oral progestogen, 11 of the 14 studies did not find a significant effect, 3 studies found decreases up to 9% to be significant from baseline (74,78) or compared with placebo (66,74,78). Among the two studies using intranasal HT, one using unopposed intranasal E 2 (97) found nonsignificant changes and one study using intranasal E 2 plus oral dydrogesterone (101) found a slight but significant increase from baseline.…”

Section: Fertility and Sterility âmentioning

confidence: 99%

“…Among these, five studies included women with CHD (31,32,36,84,95), 12 included women with established risk factors (diabetes, impaired glucose tolerance, or metabolic syndrome in 5 studies) (34,53,55,75,81), hypertension in 3 studies (45,74,78), and (mild) hypercholesterolemia in 4 studies (29,67,85,89), one included women who had undergone a hysterectomy for cervical cancer (27) and the other 52 studies included healthy postmenopausal women (including women hysterectomized for benign reasons).…”

Section: Study Characteristicsmentioning

confidence: 99%

Effects of non-oral postmenopausal hormone therapy on markers of cardiovascular risk: a systematic review

Hemelaar

Mooren

Rad

et al. 2008

Fertility and Sterility

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“…The selection of a specific antihypertensive drug in these patients should be grounded on the results of trials specifically aimed at hypertension in the older woman, taking into consideration aspects of safety and tolerability. There is increasing evidence that ACE inhibitors seem to be the medications of first choice in this population, not just because they are effective, but also because they do not cause further deterioration in the parameters of the menopausal metabolic syndrome, and since they may act in synergy with estrogen replacement therapy [31,49].…”

Section: Discussionmentioning

confidence: 99%

“…Early studies reported that menopausal women using hormone replacement therapy have lower blood pressures than controls [29,30]. In a more recent report, Affinito et al [31] found that hormone replacement therapy brought a significant reduction of blood pressure values as shown by ambulatory monitoring. Blood pressure decreased in both estrogenic and progestinic phases, and the decrease was particularly evident in daytime measurements.…”

Section: Estrogen Replacement Therapy and Hypertensionmentioning

confidence: 99%

Systemic hypertension in postmenopausal women: A clinical approach

Fisman

Tenenbaum²,

Pines³

2002

Current Science Inc

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Gender-specific differences in the incidence of cardiovascular disease have long been known, and estrogens have been considered to be responsible for this dissimilarity. Recently, the steep increase in cardiovascular risk in the no longer fertile woman has become evident. The postmenopausal metabolic syndrome is very frequent, with obesity, insulin resistance, and hyperinsulinemia, which convey increased sodium reabsorption, stimulation of the sympathetic nervous system, and smooth muscle growth. The clinical corollary of these overall changes is hypertension. Gender differences in components of the renin-angiotensin system have been shown to exist, and may play a central role in blood pressure control. In normotensive populations, plasma renin activity is significantly higher in men than in women, and is higher in postmenopausal versus premenopausal women. Two angiotensin-converting enzyme inhibitors, ramipril and moexipril, have undergone trials aimed specifically at older people with cardiovascular risk and with postmenopausal hypertension, and could be the first therapeutic choice. However, a comprehensive treatment should include nonpharmacologic measures with strong emphasis on weight normalization and regular physical activity, prevention of osteoporosis, as well as decisions on the use of estrogen replacement therapy and treatment of the menopausal metabolic syndrome. Finally, education of both patients and physicians on the nature and prognosis of untreated hypertension is crucial.

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Effects of hormonal replacement therapy in postmenopausal hypertensive patients

Cited by 44 publications

References 19 publications

Estrogen and hypertension

Estrogen and hypertension

Effects of non-oral postmenopausal hormone therapy on markers of cardiovascular risk: a systematic review

Systemic hypertension in postmenopausal women: A clinical approach

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