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Effects of hormone replacement therapy on the sympathetic nervous system and blood pressure
J Michael Wyss1, Scott H Carlson
1Department of Cell Biology, University of Alabama at Birmingham, Birmingham, AL 35294-0006, USA. jmwyss@uab.edu
Insights
Estrogen therapy may lower blood pressure by reducing sympathetic nervous system activity, potentially decreasing hypertension and cardiovascular disease risk in postmenopausal women, despite conflicting research findings.
Area of Science:
- Cardiovascular Science
- Endocrinology
- Neuroscience
Background:
- Hypertension is a leading cause of heart disease and stroke, disproportionately affecting men until menopause.
- Premenopausal women have lower cardiovascular disease incidence than men, which rises dramatically post-menopause, suggesting estrogen's protective role.
- Conflicting data exists on estrogen therapy's cardiovascular benefits, with some studies showing risks and others benefits.
Purpose of the Study:
- To review evidence on estrogen's role in modulating the sympathetic nervous system.
- To explore how estrogen influences blood pressure and cardiovascular disease incidence.
- To examine the potential of estrogen replacement therapy in managing postmenopausal hypertension.
Main Methods:
- Review of clinical and basic research studies on estrogen, blood pressure, and the sympathetic nervous system.
- Analysis of data from studies investigating estrogen's effects on arterial pressure.
- Examination of findings from the Women's Health Initiative and other relevant trials.
Main Results:
- Estrogen deficiency is linked to increased blood pressure and cardiovascular disease risk post-menopause.
- Estrogen replacement therapy shows potential in reducing blood pressure.
- Evidence suggests estrogen lowers blood pressure partly by decreasing sympathetic nervous system activity.
Conclusions:
- Estrogen plays a significant role in regulating blood pressure, particularly concerning menopause-related changes.
- Estrogen therapy may offer a strategy to reduce hypertension and cardiovascular disease in postmenopausal women.
- Further research is warranted to clarify estrogen's complex effects and optimize its therapeutic use.
Abstract:
Hypertension is a major health problem that significantly contributes to heart disease and stroke. While most studies of hypertension have focused on men, women also experience significant hypertension-related morbidity and mortality. However, the incidence of hypertension and cardiovascular disease is significantly lower in premenopausal women compared with men until the onset of menopause, at which time cardiovascular disease incidence increases dramatically in women and eventually approaches that in men. These observations indicate that the loss of estrogen contributes to menopause-related increases in blood pressure and cardiovascular disease, and suggest that the use of estrogen hormone replacement therapy could decrease the incidence of cardiovascular disease in postmenopausal women. However, new findings from the Women's Health Initiative study suggest that estrogen therapy has few positive benefits and some significant negative effects on the health of postmenopausal women, and these data have caused many to abandon long-term estrogen replacement therapy. Conversely, numerous clinical and basic research studies indicate that estrogen replacement therapy beneficially reduces blood pressure, thereby decreasing the incidence of hypertension and cardiovascular disease. Further, several of these studies suggest that one means by which estrogen lowers blood pressure is by decreasing sympathetic nervous system activity. This review examines the evidence supporting estrogen's ability to modulate sympathetic nervous system tone and thereby decrease arterial pressure.