Hormone Replacement Therapy and Blood Pressure in Hypertensive Women

Lip, Gyh; Beevers, M.; Holmes, A.M.; Churchill, David; Beevers, D. G.

doi:10.1042/cs086023pb

Cited by 38 publications

(53 citation statements)

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“…These results support the findings of a large observational study of tibolone which found no rise in blood pressure in 75 hypertensive menopausal women over 14 months. 37 The effects of tibolone on lipids were similar to those previously described with a 20-25% fall in HDL. The adverse effect on the LDL:HDL, apoB: apoA1 and apoB:(apoA1-A2) ratios imply that tibolone interfered with reverse cholesterol transport and for this reason may be deleterious.…”

Section: Discussionsupporting

confidence: 81%

A randomised placebo controlled trial of the effects of tibolone on blood pressure and lipids in hypertensive women

et al. 2000

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The effects of hormone replacement therapy in hypertensive women are controversial. This randomised placebo controlled trial assessed the effect of tibolone 2.5 mg on blood pressure and fasting plasma lipids in 29 hypertensive postmenopausal women over 6 months using a 2:1 randomisation to tibolone. The primary clinical end-point was mean office blood pressure. At 6 months systolic blood pressure declined by 5.30 ؎ 2.87% vs 4.94 ؎ 3.37% whilst diastolic blood pressure declined 5.38 ؎ 2.65% vs 0.85 ؎ 3.69% on tibolone and placebo respectively. These differences were not statistically significant. Triglycerides decreased by 33.3 ؎ 6.1% vs 7.6 ؎ 7.9% (P Ͻ 0.01) and

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Section: Discussionsupporting

confidence: 81%

A randomised placebo controlled trial of the effects of tibolone on blood pressure and lipids in hypertensive women

et al. 2000

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“…12 On the other hand Lip, Beevers and coworkers have in several papers provided evidence of the safe use of HRT in hypertensive women. [13][14][15][16] Thus there is evidence that HRT may influence BP levels and/or hypertension, but there is at present no convincing evidence of a clinically relevant effect in hypertensive women, nor is it known if the acute haemodynamic effects of oestrogen seen in animal experiments 17 are true for HRT in women. The aim of this study was to investigate the acute effects of transdermal 17-␤-oestradiol on ambulatory BP in hypertensive, postmenopausal women.…”

Section: Introductionmentioning

confidence: 99%

Transdermal oestrogen reduces daytime blood pressure in hypertensive women

et al. 1998

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The aim of this study was to investigate the acute effects of transdermally administered 17-␤-oestradiol on ambulatory blood pressure (BP) in hypertensive, postmenopausal women. Thirteen postmenopausal women with ongoing treatment for hypertension were included in this placebo-controlled, double-blind cross-over study. Ambulatory recordings of BP and heart rate were performed during 24 h on two occasions, separated by at least 1 week, after application of a patch containing either 100 g per 24 h 17-␤-oestradiol or placebo. Serum oestradiol was increased (PϽ0.001) during active treatment (139.2 ± 21.1 pg/ml) compared with the baseline postmenopausal levels recorded during placebo (40.5 ± 2.2 pg/ml). No rise in BP was found in office BP

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“…This is a relatively short period for upregulation of nitric oxide synthetase to occur which is a key factor in oestrogen mediated vasodilation. Lip et al 14 documented no time dependent increase in blood pressure over a 36-month followup period in 75 hypertensive women commenced on HRT. 14 However as there was no placebo arm in the study and as blood pressure is known to increase in a time dependent manner the possibility of a relative benefit among HRT users cannot be excluded.…”

Section: Why Should Hrt Effect Blood Pressure?mentioning

confidence: 97%

Postmenopausal hormone replacement therapy in hypertensive women: is it time for a change in attitude?

Lloyd

Jackson

1998

J Hum Hypertens

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For many years postmenopausal oestrogen replacement therapy was considered to be relatively contraindicated in women with hypertension. This reticence to use oestrogen or other forms of hormone replacement therapy (HRT) appears to stem from the experience with contraceptive dose oestrogen. The higher doses used in the oral contraceptive pill do appear to raise blood pressure among users by about 3-5%, 1 although the blood pressure normally remains within the normal range. Rarely however, some women develop severe hypertension with endorgan damage. Epidemiological evidence suggests that the menopause itself, independent of increasing age, is associated with an elevation of diastolic blood pressure by 2-3 mm Hg and an increase in the year by year rate of rise of systolic blood pressure. 2 Furthermore, it is not possible to extrapolate the effects of high dose contraceptive oestrogen to the physiological doses used in postmenopausal HRT. Why should HRT effect blood pressure?Hypertension is characterised to a varying degree by abnormal vasoconstriction, salt and water retention and impaired endothelial function. Numerous investigators have now documented the vasodilatory effects of 17-␤ oestradiol both in vivo and in vitro. 3,4 This vasodilatory effect appears to effect both the peripheral, uterine and coronary circulations and is sufficient in magnitude to bring about anti-anginal benefits for women with coronary artery disease. 5 The predominant mechanism appears to be restoration of impaired endothelial function, with paradoxical acetyl-choline induced vasoconstriction being restored to a normal vasodilatory pattern. This has been documented in the peripheral circulation utilising forearm blood flow studies and also in female coronary arteries during cardiac catheterisCorrespondence: Dr Guy Lloyd Received and accepted 9 December 1997 ation. 3,4 Aside from increased nitric oxide release, in vitro models provide evidence for more than a single mechanism of action. Investigations using preconstricted rabbit coronary artery segments have demonstrated that even when the endothelium is denuded, vasodilation continues to occur and a calcium antagonist effect has been proposed. 6 Oestradiol also antagonises the effects of endothelin-1, a potent vasoconstrictor 7 substance whose metabolism is deranged in hypertensive patients. Oestradiol, especially in contraceptive doses, exerts a mineralocorticoid effect thus promoting sodium and water retention, however to offset this effect circulating plasma angiotensin-converting enzyme activity has been demonstrated to be lower among users of HRT. 8 Oestrogen therapy has been demonstrated to increase aortic compliance and distensability providing a mechanism by which the course of systolic hypertension, prevalent in post-menopausal women might be influenced. 9 A further mechanism whereby oestrogen could effect blood pressure is through the sympathetic nervous system, an association which is mediated both centrally and at the level of the catecholamine receptor. This modulation of a...

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Hormone Replacement Therapy and Blood Pressure in Hypertensive Women

Cited by 38 publications

References 0 publications

A randomised placebo controlled trial of the effects of tibolone on blood pressure and lipids in hypertensive women

A randomised placebo controlled trial of the effects of tibolone on blood pressure and lipids in hypertensive women

Transdermal oestrogen reduces daytime blood pressure in hypertensive women

Postmenopausal hormone replacement therapy in hypertensive women: is it time for a change in attitude?

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