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The Effect of Estrogen on Blood Pressure in Hypertensive Postmenopausal Women

The authors' objectives were to investigate the effect of an oral estrogen on blood pressure and other cardiovascular risk markers, namely serum lipid and lipoprotein levels, coagulation and endothelial cell function, in postmenopausal hypertensive women. A randomized, placebo-controlled, crossover study was undertaken in a teaching hospital menopause clinic and cardiology and metabolic research departments. Twenty postmenopausal women with mild hypertension were recruited and randomized to take orally one estrogen tablet (tablets containing 0.6 mg of estradiol, 0.27 mg of estriol, and 1.4mg of estrone [Hormonin, Shire Pharmaceuticals Ltd, Andover, Hants, UK]) daily, for a period of 8 weeks, followed by 8 weeks of placebo, or vice versa. The main outcome measures were ambulatory blood pressure recordings, fasting lipid and lipoprotein levels, and coagulation indices. Results showed no significant changes in diastolic and systolic blood pressure for patients taking estrogen with respect to 24-hour and day and night readings. The mean 24-hour ambulatory blood pressure readings were 135.7 mmHg/83.9 mmHg at baseline, 131.7 mmHg/83.0 mmHg for patients receiving estrogen, and 129.9 mmHg/82.8 mmHg for patients receiving placebo. Serum levels of high-density lipoproteins and apolipoprotein AI increased significantly by 0.1 mmol/l (p = 0.005) and 32 mg/dl (p = 0.002), respectively, for patients receiving estrogen, whereas those of low-density lipoproteins and apolipoprotein B decreased by 0.7 mmol/l (p = 0.0005) and 5.5 mg/dl (p = 0.04). The only clotting factor significantly affected was plasminogen, which increased by 13.6% (p = 0.008) for patients undergoing active treatment. These results suggest that estrogens may be safely used in stable hypertensive women with no increase in ambulatory blood pressure. The changes in other risk factors were beneficial and resemble those described in normotensive postmenopausal women.