title: Hemodynamic and metabolic effects of estrogen plus progestin therapy in hypertensive postmenopausal women treated with an ACE-inhibitor or a diuretic.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Family Medicine, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-355, Poznan, Poland, malaczynska@o2.pl.
authors.forename: Anna
authors.initials: A
authors.lastname: Posadzy-Malaczynska
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Rajpold
authors.forename: Lucyna
authors.initials: L
authors.lastname: Woznicka-Leskiewicz
authors.forename: Justyna
authors.initials: J
authors.lastname: Marcinkowska
mesh_terms: D000279:Administration, Cutaneous; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure / Q000187:drug effects; D018660:Blood Pressure Monitoring, Ambulatory; D004232:Diuretics / Q000009:adverse effects / Q000627:therapeutic use*; D004338:Drug Combinations; D004347:Drug Interactions; D004958:Estradiol / Q000008:administration & dosage* / Q000009:adverse effects; D015914:Estrogen Replacement Therapy / Q000009:adverse effects; D005260:Female; D006801:Humans; D006852:Hydrochlorothiazide / Q000009:adverse effects / Q000627:therapeutic use*; D006973:Hypertension / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D007457:Iodine Radioisotopes; D007465:Iodohippuric Acid; D009640:Norethindrone / Q000008:administration & dosage* / Q000009:adverse effects; D020913:Perindopril / Q000009:adverse effects / Q000627:therapeutic use*; D011044:Poland; D019338:Polypharmacy; D017698:Postmenopause / Q000097:blood; D011372:Progestins / Q000008:administration & dosage* / Q000009:adverse effects; D063177:Pulse Wave Analysis; D017595:Renal Plasma Flow / Q000187:drug effects; D013997:Time Factors; D057968:Transdermal Patch; D016896:Treatment Outcome; D059289:Vascular Stiffness / Q000187:drug effects
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D015415:Biomarkers; D004232:Diuretics; D004338:Drug Combinations; D007457:Iodine Radioisotopes; D011372:Progestins; D006852:Hydrochlorothiazide; D007465:Iodohippuric Acid; D004958:Estradiol; D009640:Norethindrone; D020913:Perindopril