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Hemodynamic and metabolic effects of estrogen plus progestin therapy in hypertensive postmenopausal women treated with an ACE-inhibitor or a diuretic.

Posadzy-Malaczynska A, Rajpold K, Woznicka-Leskiewicz L, Marcinkowska J - Clin Res Cardiol (2014)

Bottom Line: Perindopril (4 mg/day) and hydrochlorothiazide (25 mg/day) were equally effective in reducing blood pressure in postmenopausal, hypertensive subjects.In these females, perindopril increased RPF and decreased PWV and plasma insulin levels.Concomitant estrogen plus progestin therapy may be a method to avoid unfavorable hemodynamic and metabolic effects of thiazide diuretics in hypertensive, postmenopausal women.

View Article: PubMed Central - PubMed

Affiliation: Department of Family Medicine, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-355, Poznan, Poland, malaczynska@o2.pl.

ABSTRACT

Objectives: The aim of the study was to assess the hemodynamic and metabolic actions of estrogen plus progestin therapy (EPT) in hypertensive, postmenopausal women treated with perindopril (ACEI) or hydrochlorothiazide (HCTZ). A group of normotensive postmenopausal women was also studied.

Methods: 100 hypertensive and 40 normotensive postmenopausal women were recruited for the study. The hypertensive females were randomly assigned to receive ACEI or HCTZ for 12 months. The patients of the ACEI group and the patients of the HCTZ group, as well as normotensives, were further subdivided into two subgroups each. One subgroup received estrogen plus progestin therapy (EPT+), the other subgroup received no hormone replacement (EPT-). Combined hormone replacement with transdermal patches releasing 17β-estradiol and norethisterone was used. Office and 24-hour ambulatory blood pressure was measured at baseline and during follow-up. Renal plasma flow (RPF) was measured using the clearance of [125I]-iodohippuran. Pulse wave velocity (PWV) was determined with an automatic device.

Results: In normotensive postmenopausal women, transdermal estrogen plus progestin therapy increases RPF and insulin sensitivity, decreases PWV, decreases total and LDL cholesterol, and decreases uric acid serum levels. Perindopril (4 mg/day) and hydrochlorothiazide (25 mg/day) were equally effective in reducing blood pressure in postmenopausal, hypertensive subjects. In these females, perindopril increased RPF and decreased PWV and plasma insulin levels. These effects of the ACEI were not altered by estrogen plus progestin therapy. Hydrochlorothiazide decreased RPF and increased plasma insulin and uric acid concentrations in hypertensive subjects whom were not receiving estrogen plus progestin therapy.

Conclusions: The unfavorable metabolic and hemodynamic actions of the diuretic were counteracted by estrogen plus progestin therapy. Concomitant estrogen plus progestin therapy may be a method to avoid unfavorable hemodynamic and metabolic effects of thiazide diuretics in hypertensive, postmenopausal women.

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The comparison of plasma levels of insulin, total cholesterol, LDL cholesterol, uric acid between women treated with (n = 60) or without EPT (n = 60) (EPT estrogen plus progestin therapy)
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Fig5: The comparison of plasma levels of insulin, total cholesterol, LDL cholesterol, uric acid between women treated with (n = 60) or without EPT (n = 60) (EPT estrogen plus progestin therapy)

Mentions: In multivariate analysis, we revealed significant interactions between estrogen plus progestin therapy and the type of hypotensive treatment in metabolic and hemodynamic parameters such as insulin changes (insulin delta is not shown in the table) (Fig. 1) and uric acid plasma concentrations (Fig. 2; Table 4) and as well as PWV and RPF (Table 4; Figs. 3, 4). Moreover levels of insulin, total cholesterol, LDL cholesterol, and uric acid were significantly lower in all women treated with EPT (Table 5; Fig. 5).Fig. 1


Hemodynamic and metabolic effects of estrogen plus progestin therapy in hypertensive postmenopausal women treated with an ACE-inhibitor or a diuretic.

Posadzy-Malaczynska A, Rajpold K, Woznicka-Leskiewicz L, Marcinkowska J - Clin Res Cardiol (2014)

The comparison of plasma levels of insulin, total cholesterol, LDL cholesterol, uric acid between women treated with (n = 60) or without EPT (n = 60) (EPT estrogen plus progestin therapy)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4300408&req=5

Fig5: The comparison of plasma levels of insulin, total cholesterol, LDL cholesterol, uric acid between women treated with (n = 60) or without EPT (n = 60) (EPT estrogen plus progestin therapy)
Mentions: In multivariate analysis, we revealed significant interactions between estrogen plus progestin therapy and the type of hypotensive treatment in metabolic and hemodynamic parameters such as insulin changes (insulin delta is not shown in the table) (Fig. 1) and uric acid plasma concentrations (Fig. 2; Table 4) and as well as PWV and RPF (Table 4; Figs. 3, 4). Moreover levels of insulin, total cholesterol, LDL cholesterol, and uric acid were significantly lower in all women treated with EPT (Table 5; Fig. 5).Fig. 1

Bottom Line: Perindopril (4 mg/day) and hydrochlorothiazide (25 mg/day) were equally effective in reducing blood pressure in postmenopausal, hypertensive subjects.In these females, perindopril increased RPF and decreased PWV and plasma insulin levels.Concomitant estrogen plus progestin therapy may be a method to avoid unfavorable hemodynamic and metabolic effects of thiazide diuretics in hypertensive, postmenopausal women.

View Article: PubMed Central - PubMed

Affiliation: Department of Family Medicine, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-355, Poznan, Poland, malaczynska@o2.pl.

ABSTRACT

Objectives: The aim of the study was to assess the hemodynamic and metabolic actions of estrogen plus progestin therapy (EPT) in hypertensive, postmenopausal women treated with perindopril (ACEI) or hydrochlorothiazide (HCTZ). A group of normotensive postmenopausal women was also studied.

Methods: 100 hypertensive and 40 normotensive postmenopausal women were recruited for the study. The hypertensive females were randomly assigned to receive ACEI or HCTZ for 12 months. The patients of the ACEI group and the patients of the HCTZ group, as well as normotensives, were further subdivided into two subgroups each. One subgroup received estrogen plus progestin therapy (EPT+), the other subgroup received no hormone replacement (EPT-). Combined hormone replacement with transdermal patches releasing 17β-estradiol and norethisterone was used. Office and 24-hour ambulatory blood pressure was measured at baseline and during follow-up. Renal plasma flow (RPF) was measured using the clearance of [125I]-iodohippuran. Pulse wave velocity (PWV) was determined with an automatic device.

Results: In normotensive postmenopausal women, transdermal estrogen plus progestin therapy increases RPF and insulin sensitivity, decreases PWV, decreases total and LDL cholesterol, and decreases uric acid serum levels. Perindopril (4 mg/day) and hydrochlorothiazide (25 mg/day) were equally effective in reducing blood pressure in postmenopausal, hypertensive subjects. In these females, perindopril increased RPF and decreased PWV and plasma insulin levels. These effects of the ACEI were not altered by estrogen plus progestin therapy. Hydrochlorothiazide decreased RPF and increased plasma insulin and uric acid concentrations in hypertensive subjects whom were not receiving estrogen plus progestin therapy.

Conclusions: The unfavorable metabolic and hemodynamic actions of the diuretic were counteracted by estrogen plus progestin therapy. Concomitant estrogen plus progestin therapy may be a method to avoid unfavorable hemodynamic and metabolic effects of thiazide diuretics in hypertensive, postmenopausal women.

Show MeSH
Related in: MedlinePlus