Evidence for a role of hot flushes in vascular function in recently postmenopausal women.
OBJECTIVE
Observational studies indicate that postmenopausal hormone therapy (HT) prevents cardiovascular disease, but randomized clinical trials have not confirmed this effect. Hot flushes were more likely to be present in women starting HT in observational studies, whereas these symptoms were mild or absent among women attending randomized clinical trials. We hypothesized that vascular function may differ in women with and without vasomotor hot flushes.


METHODS
One hundred forty-three recently postmenopausal women showing a broad range of variation in hot flushes were studied with radial artery tonometry. Pulse wave analyses were assessed at baseline and after nitroglycerin and salbutamol challenges. Wilcoxon signed rank test was used for paired comparisons after challenges with nitroglycerin and salbutamol.


RESULTS
Neither baseline arterial stiffness nor endothelial function differed between women without or with mild, moderate, or severe hot flushes. However, after nitroglycerin challenge, the time to the onset of the reflected wave (dependent on pulse wave velocity) was 9.5% longer (P=.014), and the time to the first systolic peak (dependent on the rapid phase of ventricular ejection) was 13.9% longer (P=.025) in women with severe hot flushes as compared with asymptomatic women.


CONCLUSIONS
Women with severe vasomotor hot flushes show greater vascular responsiveness to nitroglycerin than women without hot flushes. This may partially explain the conflicting data between observational and randomized HT studies.


BACKGROUND
ClinicalTrials.gov, www.clinicaltrials.gov, NCT00668603


METHODS
II.
Tuomikoski
Pauliina
P
From the Department of Obstetrics and Gynecology, Helsinki University Central Hospital; Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki; Division of Nephrology, Department of Medicine, Helsinki University Central Hospital; and Division of Clinical Physiology and Nuclear Medicine, Helsinki University Central Hospital, Helsinki, Finland.
Ebert
Pia
P
Groop
Per-Henrik
PH
Haapalahti
Petri
P
Hautamäki
Hanna
H
Rönnback
Mats
M
Ylikorkala
Olavi
O
Mikkola
Tomi S
TS
D000420:Albuterol / Q000494:pharmacology; D004730:Endothelium, Vascular / Q000187:drug effects* / Q000502:physiology / Q000503:physiopathology; D005260:Female; D019584:Hot Flashes / Q000453:epidemiology* / Q000473:pathology; D006801:Humans; D008875:Middle Aged; D005996:Nitroglycerin / Q000494:pharmacology; D017698:Postmenopause; D017534:Radial Artery / Q000502:physiology*; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D014665:Vasodilator Agents / Q000494:pharmacology*; D014666:Vasomotor System / Q000187:drug effects* / Q000502:physiology / Q000503:physiopathology
D014665:Vasodilator Agents; D005996:Nitroglycerin; D000420:Albuterol