Transdermal oestrogen reduces daytime blood pressure in hypertensive women

Manhem, Karin; Ahlm, Helen; Milsom, Ian; Svensson, Ann Marie

doi:10.1038/sj.jhh.1000563

Cited by 53 publications

(27 citation statements)

References 32 publications

(32 reference statements)

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“…Journal of Human Hypertension in agreement with the hypothesis that oestrogen deprivation, either at the onset of menstruation 27 or in non-substituted postmenopausal normotensive [23][24][25] or hypertensive 22 women, may increase blood pressure. Oestrogens change the loading conditions on the elastin or collagen fibres or alter the structure of the vessel wall.…”

Section: Discussionsupporting

confidence: 86%

“…18 Other studies are in keeping with our findings, but did not correct for the level of blood pressure [19][20][21] or reported that withdrawal of hormonal replacement therapy for 4 weeks resulted in a decrease of systemic arterial compliance and an increase in pulse wave velocity in the femoralisdorsalis pedis region, but not in the aorto-femoral territory. 21 Recent studies using ambulatory monitoring [22][23][24][25][26] or automated blood pressure self-measurement 27 are…”

Section: Discussionmentioning

confidence: 99%

“…Initially, the sample had been stratified by sex and age (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58)(59), у60 years), in an attempt to recruit the same number of subjects in each stratum. Households were identified from population registries as persons who shared the same address.…”

Section: Study Populationmentioning

confidence: 99%

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Menopause and the characteristics of the large arteries in a population study

et al. 2001

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In previous cross-sectional and longitudinal population studies, we found that the slope of systolic pressure on age was steeper in postmenopausal than in premenopausal women. We hypothesised that this observation could be due to a specific effect of menopause on the elasticity of the large arteries. We investigated 315 randomly selected women, aged 30 to 70 years. Based on 5.2 years of follow-up, 166 women were premenopausal and 149 menopausal (44 reaching menopause and 105 postmenopausal). These women were matched on age and body mass index with 315 men. We used a walltracking ultrasound system to measure the diameter, compliance and distensibility of the brachial and the common carotid and femoral arteries as well as carotidfemoral pulse wave velocity. Pulse pressure was determined from 24-h blood pressure recordings. Both in menopausal women (r = 0.37; P Ͻ 0.001) and in matching male controls (r = 0.16; P = 0.04), pulse pressure widened with increasing age. The slope of the 24-h pulse pressure on age was steeper in menopausal

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Study Populationmentioning

confidence: 99%

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Menopause and the characteristics of the large arteries in a population study

et al. 2001

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“…In this area there is a paucity of data. In this issue of the Journal of Human Hypertension, Manhem et al 13 have demonstrated a 3 mm drop in daytime blood pressure among pre-existing hypertensive subjects given transdermal oestrogen. The effect, although modest, represents an important observation as it is one of the few prospective randomised trials of HRT in hypertensives in which blood pressure is the primary clinical end-point.…”

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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“…4 Little information is available regarding the long-term effects of HRT in hypertensive women, but short duration studies in hypertensive women have demonstrated either a neutral or even modest hypotensive effect. [5][6][7][8][9][10] Cyclical HRT preparations are unacceptable to most women suffering from coronary disease or hypertension. Tibolone is a novel steroid compound, which controls menopausal symptoms, 11 inhibits postmenopausal bone loss 12 and augments forearm blood flow.…”

Section: Introductionmentioning

confidence: 99%

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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Transdermal oestrogen reduces daytime blood pressure in hypertensive women

Cited by 53 publications

References 32 publications

Menopause and the characteristics of the large arteries in a population study

Menopause and the characteristics of the large arteries in a population study

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

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

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