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Estrogen replacement therapy and hypertension.

The common assumption that estrogen replacement therapy (ERT) will frequently induce or aggravate hypertension cannot be supported by current evidence. While hypertension may occur as a rare idiosyncratic reaction to ERT, studies strongly suggest that blood pressure, systolic and diastolic, is consistently lowered by estrogen administration, although the decrement is small. There are suggestive data that on a weight basis, natural human estrogens have less of an effect on the renin-angiotensin system than do conjugated and synthetic estrogens, but the clinical significance of these findings has not been demonstrated. ERT need not be withheld because of theoretical blood pressure concerns or the presence of hypertension.