One year follow-up of hormone replacement therapy with percutaneous estradiol and low-dose vaginal natural progesterone in women with mild to moderate hypertension.

Objective: The effects of natural estradiol and progesterone replacement therapy on lipoprotein and cardiovascular parameters were assessed in 20 postmenopausal women with mild to moderate systemic arterial hypertension.

Design: After confirming hypertension in the absence of antihypertensive treatment, blood pressure control was achieved by administration of amlodipine at individually adjusted doses. Hormone replacement therapy (HRT) was introduced in a cyclic regimen (21 of 28 days) with percutaneous estradiol (1.5 mg/day) and vaginal micronized progesterone (100 mg/day).

Results: Blood pressure and mean heart rate remained unchanged during HRT. Serial echocardiograph scans showed no change in left ventricle mass, but a significant reduction in the thickness of the left ventricular posterior wall was observed. During treatment, patients showed little variation in total cholesterol levels (baseline: 199+/-10 mg/dl, 12 months: 202+/-11 mg/dl), as well as in high-density lipoprotein (53+/-2 to 50+/-3 mg/dl), low-density lipoprotein (122+/-10 to 118+/-11 mg/dl), and triglycerides (111+/-13 to 126+/-13 mg/dl). A subgroup of 10 patients with initial total cholesterol levels >200 mg/dl responded to HRT with a slight but significant decrease of cholesterol levels after 12 months (265+/-10 to 237+/-12 mg/dl, p<0.05, repeated measures ANOVA). HRT did not change mean antithrombin III levels and affected neither plasma renin activity nor aldosterone levels.

Conclusion: These results suggest that the proposed HRT regimen with percutaneous estradiol associated with low-dose vaginal micronized progesterone could be a safe alternative for postmenopausal women with hypertension at least during the period required to treat menopausal symptoms.