Blood Pressure In Postmenopausal Women Research Articles

Drospirenone and 17-β Estradiol Reduces 24-Hour Blood Pressure in Postmenopausal Women With Hypertension

Drospirenone and 17-β Estradiol Reduces 24-Hour Blood Pressure in Postmenopausal Women With Hypertension

Effects of raloxifene therapy on plasma renin and aldosterone levels and blood pressure in postmenopausal women

Objective. Blood pressure, which generally increases after menopause, is one of the best tools to characterize cardiovascular disease. The renin–aldosterone system plays a role in determining cardiovascular risk and the role of estrogen in the regulation of angiotensinogen gene expression and serum levels is well known. Raloxifene can induce endothelium-dependent vasodilation without affecting endothelium-independent vasorelaxation. The aim of the study was to investigate the effects of raloxifene on the renin–aldosterone system and blood pressure in postmenopausal women.Designs. Forty women, 54–59 years of age, in physiological menopause for 6 months to 4 years, were enrolled in the study and treated with raloxifene 60 mg/day for 6 months. All had blood pressure less than 130/85 mm Hg at the start of the study. The women were divided into two groups: the first (group A; 20 women) with normal blood pressure and the second (group B; 20 women) with previous high blood pressure treated with antihypertensive drugs, not angiotensin-converting enzyme inhibitors or angiotensin receptor blockers.Results. No significant changes in plasma renin activity (PRA) or plasma concentrations of aldosterone were observed between the two groups after 6 months of raloxifene use. There was a slight reduction in PRA (11±4% for group A and 13±5% for group B) and in plasma levels of aldosterone (3.6±0.5% and 4.6±0.5%, respectively) with respect to basal values, but neither change was statistically significant.Conclusions. The results of the present study show that raloxifene at 60 mg/day dose is well tolerated and has no clinical impact on blood pressure, PRA or aldosterone in postmenopausal women.

The long-term effects of low-dose 17β-estradiol and dydrogesterone hormone replacement therapy on 24-h ambulatory blood pressure in hypertensive postmenopausal women: a 1-year randomized, prospective study

Objective The aim of this study was to assess the long-term effects of low-dose oral hormone replacement therapy (HRT) on 24-h blood pressure in hypertensive postmenopausal women.Study design In this 12-month, prospective study, 66 postmenopausal women with mild or moderate hypertension were randomly assigned to receive either HRT with 1 mg/day micronized 17β-estradiol sequentially combined with 10 mg/day dydrogesterone for 14 days of each 28-day cycle, or no therapy. Ambulatory blood pressure measurements were recorded for a 24-h period at baseline and after 12 months of treatment or follow-up.Results Blood pressure did not differ significantly between the groups at baseline. After 12 months, there were falls in 24-h systolic, diastolic and mean arterial blood pressure in both the HRT and control groups; only the fall in mean arterial blood pressure in the HRT group achieved statistical significance (−2.0 ± 0.8 mmHg, p < 0.01). While there was no significant decrease in daytime systolic or mean arterial blood pressure in either group, a significant decrease in diastolic blood pressure (−1.8 ± 10 mmHg, p < 0.001) was observed in the HRT group. Night-time systolic and mean arterial blood pressure also decreased significantly (p < 0.001) in the HRT group (−3.0 ± 1.5 mmHg and −2.2 ± 0.6 mmHg, respectively), but no significant change was observed in the control group.Conclusion Low-dose oral HRT caused significant falls in both daytime and night-time ambulatory blood pressure in postmenopausal women with mild or moderate hypertension.

Postmenopausal oral estrogen therapy and blood pressure in normotensive and hypertensive subjects: the Estrogen in the Prevention of Atherosclerosis Trial

To determine if 17beta-estradiol increases blood pressure in postmenopausal women. A total of 222 healthy postmenopausal women were randomly assigned to either 1 mg micronized 17beta-estradiol daily or placebo for 2 years. Blood pressure measurements were obtained every other month and common carotid artery intima-media thickness measured every 6 months. Statistical analyses comparing longitudinal changes in systolic and diastolic blood pressure between treatment groups used a mixed general linear model including interaction terms to evaluate variations by age or estradiol level. Both placebo and estradiol groups showed small declines in systolic and diastolic blood pressure during the trial among the normotensive subjects and subjects on antihypertensive medications. However, the decline did not differ significantly between the groups. Treatment effects on systolic blood pressure differed significantly by the age of the subject (interaction P value = 0.04) with younger women on estradiol showing on average a rise in systolic blood pressure, and older women a decline. The association between serum estradiol level and systolic blood pressure showed a similar modification with age (P = 0.03). Changes in systolic blood pressure in women on estradiol were positively correlated with intima-media thickness progression (P = 0.03). Overall, 17beta-estradiol did not influence changes in blood pressure in normotensive or hypertensive women. The effect of 17beta-estradiol treatment on systolic blood pressure may be influenced by a woman's age. Estradiol may increase systolic blood pressure in younger postmenopausal women, while having the opposite effect in older postmenopausal women.

Angiotensin II Plays an Important Role in Maintaining Blood Pressure in Postmenopausal Women Receiving Hormone Replacement Therapy

We investigated the role of angiotensin (Ang) II in maintaining blood pressure (BP) by administering a small dose of candesartan, an Ang II type 1 receptor antagonist, in postmenopausal women receiving long-term hormone replacement therapy (HRT). A single dose of 2 mg of candesartan was administered orally to 13 normotensive postmenopausal women receiving HRT (continuous combined conjugated estrogen and medroxyprogesterone acetate orally; HRT group) and 13 normotensive postmenopausal women not receiving HRT (control group). Both BP and heart rate (HR) were measured at baseline and at 1, 2, 3, 4, 5, and 6 h after administration. Plasma renin activity (PRA) and Ang I, Ang II, and bradykinin concentrations were measured at baseline and 4 h after the administration of candesartan. Candesartan lowered the BP and raised the HR in both groups. However, the decrease in BP was significantly greater in the HRT group than in the control group (P < .05), whereas no significant difference in the change in HR was observed between the two groups. In the HRT group, significant increases were found in PRA, Ang I, and Ang II (all P < .05) and a significant decrease in bradykinin (P < .01) with candesartan treatment. In the control group, candesartan as associated with an increase in PRA (P < .05) but not in Ang I, Ang II, or bradykinin. Based on our study results, Ang II plays an important role in maintaining BP in normotensive postmenopausal women receiving HRT. Maintenance of BP may be dependent on the balance between the hypertensive effect of Ang II and the hypotensive effect of bradykinin.

Antihypertensive Effects of Drospirenone With 17β-Estradiol, a Novel Hormone Treatment in Postmenopausal Women With Stage 1 Hypertension

Drospirenone (DRSP) is a novel progestin with antimineralocorticoid activity that has been developed for hormone therapy in combination with 17beta-estradiol (E2) in postmenopausal women. In prior studies with DRSP in postmenopausal women that were focused on relief of menopausal symptoms, DRSP/E2 yielded significant reductions in blood pressure (BP). The effects of 3 mg DRSP/1 mg E2 on clinic and 24-hour ambulatory BP as well as potassium homeostasis were evaluated in postmenopausal women with stage 1 hypertension (systolic, 140 to 159 and/or diastolic, 90 to 99 mm Hg) in a 12-week, multicenter, double-blind, randomized, placebo-controlled study. Clinic BPs were measured at baseline and at 2, 4, 6, 8, and 12 weeks of therapy, whereas potassium was measured at 2, 6, and 12 weeks of therapy. Ambulatory BP was performed in a substudy at baseline and at the end of the trial. In the intention-to-treat population of 213 women, the clinic BP was reduced significantly on DRSP/E2 (clinic BP, -14.1/-7.9 for DRSP/E2 versus -7.1/-4.3 mm Hg for placebo, P<0.0001). In the subgroup of 43 women with ambulatory BP monitoring, the 24-hour BP fell by -8.5/-4.2 mm Hg versus -1.8/-1.6 mm Hg on placebo (P=0.002/0.07). There were no significant changes from baseline in potassium levels or in the incidence of hyperkalemia (> or =5.5 meq/L) on DRSP/E2 compared with placebo. Combination therapy with DRSP/E2 significantly lowered both clinic and 24-hour systolic BP in postmenopausal women with stage 1 systolic hypertension. This characteristic may lead to benefit for cardiovascular risk reduction in this population.

Hormone replacement therapy and arterial blood pressure in postmenopausal women with hypertension

Background. Data on the effect of hormone replacement therapy (HRT) on blood pressure (BP) in hypertensive menopausal women are limited. Objective. To investigate the association between HRT and longitudinal changes in BP in hypertensive menopausal women. Patients and methods. We recruited a total of 161 hypertensive menopausal women (mean age = 52.2±6.6 years) attending the hypertension clinic in our hospital that required HRT to attenuate the effect of menopause symptoms. These women were followed for up to 36 months, being evaluated every 6 months with measurements of their BP, weight and the number of drugs needed to control their BP. We also measured serum cholesterol levels before and after the initiation of HRT. Results. The systolic BP remained unaffected throughout the whole follow‐up period, whereas the diastolic BP was slightly reduced at 6, 24 and 36 months. This decrease was accompanied by an increased need for antihypertensive medication throughout the entire follow‐up period, while the body weight also increased at 18, 24 and 36 months. No particular differences were noted with respect to ethnicity, history of pre‐eclampsia or surgical menopause, before and after the initiation of HRT. Serum cholesterol levels remained unchanged during the evaluation period. Oestrogen–progestogen combination therapy use was associated with a lower diastolic BP and a smaller number of antihypertensive drugs compared to other forms of HRT. Conclusion. HRT use does not have an adverse gross effect on BP in hypertensive menopausal women who need it, although there may be an increased need for antihypertensive therapy during the 36‐month follow‐up period of our study.

INFLUENCE OF MENOPAUSE ON BLOOD PRESSURE DIPPING IN WOMEN WITH METABOLIC SYNDROME: A CASE-CONTROL STUDY

Aim. To study if menopause influences the blood pressure (BP) decrease level during nighttime in women with metabolic syndrome. Methods. 84 women with metabolic syndrome are examined, from them 52 are in postmenopause (average age is 56 [SD 5] years) and 32 are in premenopause (average age is 44 [5] years). Anthropomorphic measurements were made, levels of office BP and heart rate were assessed, ambulatory BP monitoring was carried out, lipids and glucose of blood serum were studied. Results. Clinical parameters, characterizing metabolic syndrome, didn’t vary between the groups. Number of patients with insufficient decrease of BP in postmenopausal women didn’t differ significantly from the number of such women in premenopausal period (for systolic BP: 64% versus 52%, p=0,288; for diastolic BP: 34% versus 42%, p=0,469). Nevertheless, when evaluating the level of systolic BP decrease during nighttime as continuous variable, significant differences between groups are revealed (M±SEM [95% CI]: 4.4±1.5% [1.4-7.3] in postmenopausal women versus 11.3±1.7% [7.9-14.8] in premenopausal women, p=0,011). Conclusion. Postmenopause associates with insufficient systolic BP decrease during nighttime in women with metabolic syndrome.

Ambulatory blood pressure monitoring and active renin in menopausal women treated with amlodipine and hormone replacement therapy

The aim of this study was to follow up the effect of an 8-week treatment with amlodipine given alone or in combination with hormone replacement therapy (HRT) on blood pressure and active renin in postmenopausal women with mild to moderate arterial hypertension using both conventional clinical blood pressure measurements and ambulatory blood pressure monitoring. Twenty-nine hypertensive menopausal women were divided randomly into two groups according to the treatment regimens: amlodipine and amlodipine plus HRT. The combination with HRT led to normalization of 24-h and daytime systolic and diastolic blood pressure. In contrast to the group treated with amlodipine alone, where a significant fall only of systolic night-time blood pressure was observed, in the group treated with amlodipine plus HRT both systolic and diastolic night-time blood pressure decreased significantly. Active renin did not change significantly after treatment in both groups. Triglycerides decreased significantly and high-density lipoprotein-cholesterol increased significantly only after amlodipine treatment. There were no significant differences in serum total cholesterol and low-density lipoprotein-cholesterol after HRT plus amlodipine. In conclusion, amlodipine is effective in reducing blood pressure in postmenopausal women. The maintenance of a normal circadian blood pressure pattern was influenced by HRT.

Administration of tibolone decreases 24 h heart rate but not blood pressure of post-menopausal women

Objective: Elevation of blood pressure and heart rate increase the risk of cardiovascular disease. Administration of estrogens does not affect heart rate but may decrease 24 h blood pressure. In this study, we tested the effect of the estro-progestogenic compound tibolone. Methods: Thirty healthy, post-menopausal women were randomized to receive placebo ( n=15) or tibolone, at the commonly prescribed dose of 2.5 mg per day ( n=15). Before and after 6 months of treatment, in each woman blood pressure and heart rate were monitored every 30 min for 41 h by an ambulatory device. Valuable readings were those collected from 8:00 a.m. of the second day to 8:00 a.m. of third day. Analyses were performed of 24 h, day-time (7:00 a.m.–11:00 p.m.) and night-time (11:00 p.m.–7:00 a.m.) values. Day to night difference was also calculated. Results: Placebo did not modify 24 h, day-time, and night-time blood pressure or heart rate values. Day–night differences were also not affected by placebo. Similarly to placebo, tibolone administration did not modify any of the blood pressure parameters taken into consideration. By contrast, a significant decline of 24 h heart rate (73.2±2.3 beats/min versus 69.3±1.7 beats/min; P<0.0008) was observed. The effect was significant both at day (76.6±2.4 beats/min versus 72.1±1.9 beats/min; P<0.0001) and night (65.8±2.6 beats/min versus 62.4±1.9 beats/min; P<0.05). Day–night blood pressure and heart rate differences were not affected by tibolone. Conclusions: In post-menopausal women, administration of tibolone does not influence 24 h blood pressure but reduces heart rate.

Administration of raloxifene does not influence 24-hour ambulatory blood pressure of postmenopausal women with osteopenia: A double-blind placebo-controlled study

Objective: Because estrogens may decrease 24-hour blood pressure of postmenopausal women, we tested the effect of the selective estrogen receptor modulator raloxifene on ambulatory blood pressure. Study Design: Postmenopausal women with osteopenia who were otherwise healthy were assigned randomly in a double blind-fashion to receive placebo (n = 16 women) or raloxifene (60 mg/d, n = 16 women). Before and after 4 months, the blood pressure of each woman was monitored every 30 minutes for 41 hours with the use of an ambulatory device. Results: Similar to the placebo outcome, the raloxifene administration did not modify 24-hour daytime(7 AM −11 PM ) and nighttime (11 PM −7 AM ) blood pressure and heart rate values. Day-night differences and the 24-hour rhythmic variation of mean blood pressure, which was evaluated by cosinor analysis, were also not affected by placebo or by raloxifene. Conclusion: Raloxifene does not influence 24-hour blood pressure of postmenopausal women. These data are reassuring for the cardiovascular safety of the long-term raloxifene administration. (Am J Obstet Gynecol 2003;188:1278-82.)

Angiotensin II type 1 receptor blockade to control blood pressure in postmenopausal women: Influence of hormone replacement therapy

Hypertension is twice as common in postmenopausal than in premenopausal women. This study evaluated the effectiveness of a blockade of the renin-angiotensin-aldosterone system (RAAS) with candesartan cilexetil (CC) to control blood pressure (BP) in hypertensive menopausal women, and the influence of hormone replacement therapy (HRT). This was designed as a prospective, open-label and non-comparative study. Included were 618 hypertensive menopausal women grade I/II according to the Sixth Report of the Joint National Committee (VI-JNC), with an average age 52+/-4.7 years (95% CI 52.3-53.0) and with a last menstrual period (LMP) at least one year before. BP was determined by measurement in four visits during six months of follow-up, according to the recommendations of the OMS/SIH. Optimal control of BP was considered as BP <140/90 mm Hg. A statistically significant decrease in systolic (SBP; 19.9+/-11.2) and diastolic (DBP; 11.5+/-7.3) blood pressure mm Hg values was observed (P<0.01). The control of BP increased significantly over time to 61.2% (P<0.01). In multivariate analysis, only age was associated with control of BP (beta= -0.062; P=0.004). Of the women not controlled in the second visit, 12.5 mg of hydrochlorothiazide (HCTZ) were added to 31.5% (N=122), with 80% more BP control achieved in visit 3 than in the non-supplement group (OR=1.8; 95% CI 1.04-3.05; P<0.03). One hundred and three (16.7%) patients were receiving HRT for 2.01+/-2.23 years (95% CI 1.55-2.46). HRT did not affect the control of BP. No severe adverse reactions were reported. Candesartan cilexetil significantly reduced SBP and DBP and increased control (61.2%) of BP in hypertensive menopausal women. Only age had an inverse association with control of BP. In this study, HRT did not affect the control of BP.

Hormone replacement therapy and hypertension

Hypertension, particularly systolic hypertension, affects postmenopausal women and is an important risk factor for cardiovascular disease in this group. In the last year, several papers have better defined the mechanisms by which hormone replacement therapy influences blood pressure in postmenopausal women, including effects on nitric oxide, angiotensin II and vascular stiffness (compliance). Currently, data concerning the influence of hormone replacement therapy on blood pressure in postmenopausal women are inconclusive because of the limitations of published studies. It is clear, however, that hypertension is not a contraindication to starting hormone replacement therapy.

Hormone replacement therapy and hypertension.

Hypertension, particularly systolic hypertension, affects postmenopausal women and is an important risk factor for cardiovascular disease in this group. In the last year, several papers have better defined the mechanisms by which hormone replacement therapy influences blood pressure in postmenopausal women, including effects on nitric oxide, angiotensin II and vascular stiffness (compliance). Currently, data concerning the influence of hormone replacement therapy on blood pressure in postmenopausal women are inconclusive because of the limitations of published studies. It is clear, however, that hypertension is not a contraindication to starting hormone replacement therapy.

Resistive index of renal artery and blood pressure in postmenopausal women

Causal association between perimenopausal changes and symptoms and disease is commonly accepted even if not definitely explained. Resistive index (RI) of renal artery assessed by Doppler echography is related to renal function and systemic circulatory adaptation in patients with chronic renal failure and hypertension. Echocardiographic measurement of left ventricular myocardial mass (LVMM) is a useful tool for assessing effects of arterial hypertension on heart. Aim of the study was to assess RI in normotensive postmenopausal women and relationship, if any, with blood pressure and LVMM. We studied 28 normotensive, non-obese postmenopausal women, age 52.21±5.40 years, with normal creatinine clearance. Renal colour-Doppler echography was performed assessing intra-parenchimal renal artery mean velocity (mVRA) and intra-parenchimal RI [(peak systolic velocity−end diastolic velocity)/peak systolic velocity]. Echocardiography was performed as well. RI of intra-parenchimal renal artery is 0.67±0.05 and it shows correlations vs. diastolic blood pressure ( r=0.41; P<0.03) and vs. mean BP ( r=0.47; P<0.01). LVMM has correlation ( r=0.41; P>0.03) with RI. Age, body weight, body mass index, menarche age, fertility years and postmenopausal years do not show correlation with RI. Heart rate, creatinine clearance, hemoglobin, serum albumin do not show any correlation with RI. Higher RI is associated with alcohol intake, liver steatosis, biliary gallstones and family history of diabetes mellitus, but not with postmenopausal years, unrespective of surgical or non-surgical menopause. Among echocardiographic measurements only LVMM is correlated with RI; mVRA does not show correlation. LVMM and BP do not show other independent correlation except that the one already reported vs. RI. RI, as a pathophysiological measurement whose increase preludes to arterial hypertension, could help to ascertain perimenopausal women at risk for arterial hypertension and left ventricular hypertrophy, but does not seem directly associated with the loss of ovarian function.

The Effects of Hormone Replacement Therapy on Blood Pressure in Postmenopausal Women

The Effects of Hormone Replacement Therapy on Blood Pressure in Postmenopausal Women

Hormone replacement therapy and longitudinal changes in blood pressure in postmenopausal women.

The incidence of hypertension in postmenopausal women exceeds that in age-matched men. Longitudinal studies relating hormone replacement therapy (HRT) to blood pressure changes are sparse. To investigate the association between HRT and longitudinal changes in blood pressure in postmenopausal women. Longitudinal observational study. Community-dwelling volunteers. 226 healthy, normotensive postmenopausal women from the Baltimore Longitudinal Study of Aging with a mean (+/-SD) age of 64 +/- 10 years were followed for 5.7 +/- 5.3 years. Seventy-seven women used both estrogen and progestin, and 149 used neither. Lifestyle variables, blood pressure, and traditional cardiovascular risk factors were measured at baseline and approximately every 2 years thereafter. Systolic blood pressure at baseline was similar in HRT users and nonusers (133.9 +/- 16.0 mm Hg vs. 132.4 +/- 14.8 mm Hg). Over time, average systolic blood pressure increased less in HRT users than nonusers, independent of other cardiovascular risk factors, physical activity, and alcohol use. For example, HRT users who were 55 years of age at their first Baltimore Longitudinal Study of Aging visit experienced a 7.6-mm Hg average increase in systolic blood pressure over 10 years; in contrast, the average increase in nonusers was 18.7 mm Hg. The lesser increase in systolic blood pressure in HRT users was more evident at older age. Diastolic blood pressure, which did not change statistically over time in either group, was not associated with HRT. Postmenopausal women taking HRT have a smaller increase in systolic blood pressure over time than those not taking HRT. This difference is intensified at older ages.

Gender differences in the regulation of blood pressure.

Men are at greater risk for cardiovascular and renal disease than are age-matched, premenopausal women. Recent studies using the technique of 24-hour ambulatory blood pressure monitoring have shown that blood pressure is higher in men than in women at similar ages. After menopause, however, blood pressure increases in women to levels even higher than in men. Hormone replacement therapy in most cases does not significantly reduce blood pressure in postmenopausal women, suggesting that the loss of estrogens may not be the only component involved in the higher blood pressure in women after menopause. In contrast, androgens may decrease only slightly, if at all, in postmenopausal women. In this review the possible mechanisms by which androgens may increase blood pressure are discussed. Findings in animal studies show that there is a blunting of the pressure-natriuresis relationship in male spontaneously hypertensive rats and in ovariectomized female spontaneously hypertensive rats treated chronically with testosterone. The key factor in controlling the pressure-natriuresis relationship is the renin-angiotensin system (RAS). The possibility that androgens increase blood pressure via the RAS is explored, and the possibility that the RAS also promotes oxidative stress leading to production of vasoconstrictor substances and reduction in nitric oxide availability is proposed.

Differential effects of transdermal vs. oral estrogen on sympathetic nerve activity and blood pressure in postmenopausal women

Differential effects of transdermal vs. oral estrogen on sympathetic nerve activity and blood pressure in postmenopausal women

Randomized comparison between orally and transdermally administered hormone replacement therapy regimens of long-term effects on 24-hour ambulatory blood pressure in postmenopausal women

Objective: The aim of this study was to assess whether oral delivery and transdermal delivery of sequential combined hormone replacement therapy have similar effects on systemic blood pressure, as measured by 24-hour automated ambulatory recordings. Study Design: Eighty-two healthy postmenopausal women, of whom 73 completed the study, were randomly assigned to start hormone replacement therapy with either orally (n = 38) or transdermally (n = 35) administered medication. Ambulatory blood pressure was recorded for a 24-hour period before the start of hormone replacement therapy and again 2 and 6 months later. Analysis of variance was used for data analysis. Results: Hormone replacement therapy by both oral and transdermal routes was associated with slight but nonsignificant drops in mean 24-hour systolic and diastolic ambulatory blood pressure. Daytime systolic ambulatory blood pressure (mean ± SE) fell significantly (P <.05) and similarly at 2 months in the oral (3.8 ± 0.2 mm Hg) and transdermal (4.0 ± 0.3 mm Hg) treatment groups. The daytime ambulatory blood pressure remained significantly lower than baseline at 6 months in the oral treatment group (–3.6 ± 0.3 mm Hg), whereas the fall at 6 months in the transdermal group (–3.1 ± 0.3 mm Hg) was not significant. Mean daytime diastolic ambulatory blood pressure was reduced in both the oral (–1.8 ± 0.8 mm Hg) and transdermal (–3.5 ± 0.7 mm Hg; P <.05) treatment groups at 2 months but not at 6 months. Nighttime ambulatory blood pressures in both groups remained unaffected by hormone replacement therapy. Conclusion: Sequential combined hormone replacement therapy delivered by both oral and transdermal routes caused significant falls in the daytime ambulatory blood pressure of normotensive postmenopausal women at 2 months of treatment. This fall persisted as long as 6 months of treatment in the oral treatment group but not in the transdermal treatment group. (Am J Obstet Gynecol 2001;184:904-9.)