title: Temporal changes in clinic and ambulatory blood pressure during cyclic post-menopausal hormone replacement therapy.
abstract: OBJECTIVE
  Post-menopausal hormone replacement (HRT) might protect against cardiovascular disease, possibly by arterial vasodilation and reduced blood pressure. Progestogens are needed to avoid endometrial disease but vascular effects are controversial. The objective was to assess temporal changes in blood pressure (BP) by two measurement techniques during a cyclic hormone replacement regimen.
  
  
  METHODS
  Sixteen healthy and normotensive post-menopausal women (age 55 +/- 3 years) were studied in a placebo-controlled, randomized crossover study, and were randomized to 17beta-oestradiol plus cyclic norethisterone acetate (NETA) or placebo in two 12-week periods separated by a 3-month washout Clinic blood pressure was measured sitting by the same observer with a mercury manometer at four visits in each period. Twenty-four hour ambulatory blood pressure was measured at baseline and in the ninth weeks of treatment in both periods.
  
  
  RESULTS
  Clinic systolic and diastolic BP were reduced after 10 days of oestradiol (-5.1 and -3.2 mmHg respectively, P < or = 0.05). After 9 weeks of cyclic HRT, prior to progestogen addition, clinic BP returned to baseline. During addition of NETA, diastolic blood pressure was again reduced (-3.6 mmHg, P= 0.037). Mean 24 h ambulatory systolic and diastolic blood pressures were significantly lower than clinic measurements (-15.7 and -5.9 mmHg, P < 0.001) but were unaffected by HRT.
  
  
  CONCLUSIONS
  Clinic blood pressure is reduced during a cyclic HRT regimen but the reduction varies with the HRT regimen, which might explain the diversity in previous BP findings during HRT. Norethisterone acetate might possess additive blood pressure-lowering effects in postmenopausal women.
authors.affiliation: Department of Obstetrics, and Gynaecology, Hvidovre Hospital, University of Copenhagen, Denmark. m.sorensen@rbh.nthames.nhs.uk
authors.forename: M B
authors.initials: MB
authors.lastname: Sørensen
authors.forename: V
authors.initials: V
authors.lastname: Rasmussen
authors.forename: G
authors.initials: G
authors.lastname: Jensen
authors.forename: B
authors.initials: B
authors.lastname: Ottesen
mesh_terms: D001794:Blood Pressure / Q000187:drug effects*; D018660:Blood Pressure Monitoring, Ambulatory; D001835:Body Weight / Q000187:drug effects; D004311:Double-Blind Method; D015914:Estrogen Replacement Therapy; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D006801:Humans; D008875:Middle Aged; D011374:Progesterone / Q000494:pharmacology; D013315:Stress, Psychological / Q000097:blood
chemical_list: D011374:Progesterone; D005640:Follicle Stimulating Hormone