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Effects of hormone therapy on blood pressure
Zeinab Issa1, Ellen W Seely, Maya Rahme
1From the 1Endocrine Division, American University of Beirut, Beirut, Lebanon; 2Endocrine Hypertension Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; 3Endocrine Division, Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders; and 4Scholars in Health Research Program, American University of Beirut, Beirut, Lebanon.
Insights
Hormone therapy for menopause symptoms generally has a neutral effect on blood pressure. Transdermal estrogen and progesterone may benefit blood pressure, while oral forms are neutral, especially in hypertensive women.
Area of Science:
- Endocrinology and Reproductive Medicine
- Cardiovascular Health
- Pharmacology
Background:
- Hormone therapy (HT) is effective for menopausal vasomotor symptoms.
- The impact of HT on blood pressure (BP) requires clarification.
- Understanding HT's effects on BP is crucial for patient safety.
Purpose of the Study:
- To review evidence on HT mechanisms affecting BP.
- To analyze clinical data on HT's impact on blood pressure.
- To assess HT's role in managing menopausal symptoms and cardiovascular risk.
Main Methods:
- Searched Ovid MEDLINE (2000-2013) for "hypertension" and "hormone therapy and menopause" or "selective estrogen receptor modulator".
- Reviewed in vitro, physiologic, and clinical study data.
- Focused on studies with BP as a primary outcome.
Main Results:
- In vitro/physiologic studies showed no clear negative HT effect on BP.
- Oral HT was neutral on BP in large trials (normotensive/hypertensive women).
- Transdermal estrogen/progesterone showed BP benefits in normotensive women and was neutral in hypertensive women. Tibolone and raloxifene were neutral on BP.
Conclusions:
- Large trials are needed for oral HT in hypertensive women and transdermal HT in all women.
- Transdermal preparations are preferred for hypertensive women due to favorable profiles.
- Individualized HT decisions require BP monitoring during treatment.
Objective:
Although hormone therapy remains the most efficacious option for the management of vasomotor symptoms of menopause, its effects on blood pressure remain unclear. This review scrutinizes evidence of the mechanisms of action of hormone therapy on signaling pathways affecting blood pressure and evidence from clinical studies.
Methods:
Comprehensive Ovid MEDLINE searches were conducted for the terms "hypertension" and either of the following "hormone therapy and menopause" or "selective estrogen receptor modulator" from year 2000 to November 2013.
Results:
In vitro and physiologic studies did not reveal a clear deleterious effect of hormone therapy on blood pressure. The effect of oral therapy was essentially neutral in large trials conducted in normotensive women with blood pressure as primary outcome. Results from all other trials had several limitations. Oral therapy had a neutral effect on blood pressure in hypertensive women. Transdermal estrogen and micronized progesterone had a beneficial effect on blood pressure in normotensive women and, at most, a neutral effect on hypertensive women. In general, tibolone and raloxifene had a neutral effect on blood pressure in both hypertensive and normotensive women.
Conclusions:
Large randomized trials are needed to assess the effect of oral hormone therapy on blood pressure as a primary outcome in hypertensive women and the effect of transdermal preparations on both normotensive and hypertensive women. Transdermal preparations would be the preferred mode of therapy for hypertensive women, in view of their favorable physiologic and clinical profiles. The decision regarding the use of hormone therapy should be individualized, and blood pressure should be monitored during the course of treatment.
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