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[Hypertension and menopausal hormone therapy].

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Summary

Menopausal hormone therapy (HT) in hypertensive women requires careful consideration. Transdermal HT appears safer than oral HT, with benefits depending on the intervention window and patient age.

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Area of Science:

  • Cardiovascular Health
  • Endocrinology
  • Women's Health

Background:

  • Menopausal hormone therapy (HT) use is debated in women with hypertension due to potential cardiovascular risks.
  • Previous studies on oral HT raised concerns about increased cardiovascular events and breast cancer.
  • The optimal timing and patient profile for initiating HT remain critical considerations.

Purpose of the Study:

  • To evaluate the safety and efficacy of menopausal hormone therapy (HT) in women with hypertension.
  • To review recent scientific literature on HT and its impact on blood pressure and cardiovascular outcomes.
  • To provide guidance on prescribing HT for hypertensive women experiencing menopausal symptoms.

Main Methods:

  • A comprehensive review of recent scientific literature was conducted by experts from the French Society of Hypertension.
  • Analysis focused on randomized trials and observational studies concerning oral and transdermal HT.
  • Cardiovascular risk factors, intervention timing, and age-related effects were assessed.

Main Results:

  • Oral HT may be associated with a slight increase in blood pressure.
  • Transdermal HT appears to be a safer route of administration.
  • Initiating HT within 10 years of menopause and at a younger age may reduce cardiovascular risks and potentially decrease coronary events.

Conclusions:

  • Prescribing HT for hypertensive women with significant menopausal symptoms necessitates a thorough cardiovascular risk assessment.
  • The choice of HT route is crucial, with a preference for transdermal administration when feasible.
  • An algorithm for prescription assistance is proposed, stratifying cardiovascular risk and favoring transdermal HT.