[Hormone replacement therapy in hypertension in the postmenopausal woman]

Naturally occurring or surgically related hormonal deprivation at menopause is associated with cardiovascular and non-cardiovascular complications. Hormonal replacement therapy helps to prevent and treat these complications, not only symptoms associated with menopause (which continue to be their major indication) but also bone and cardiovascular related problems. It is well known that oral contraceptive use is one of the most common reversible causes of secondary hypertension. This is, in part, why the use of hormonal replacement therapy has provoked such suspicion among clinicians who have mainly believed that a similar effect on blood pressure would probably occur with the use of hormonal replacement therapy. However, the results of a variety of clinical studies and surveys do not confirm these suspicions. These beneficial effects have to be weighed against the risk of endometrial hyperplasia, endometrial cancer and breast cancer (among other unwanted effects) that could occur when long-term therapy is implemented. If one considers that the overall risk associated with cardiovascular mortality is more than four times higher than the risk associated with gynecological malignancies, even a modest decrease in the cardiovascular risk could easily outweigh other risks and result in an overall improved risk profile in postmenopausal women.