Estradiol with or without progesterone and ambulatory blood pressure in postmenopausal women.
Estradiol with or without progesterone and ambulatory blood pressure in postmenopausal women.
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DOI：
10.1161/01.hyp.33.5.1190
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发表时间：
1999-05
期刊：
影响因子：
8.3
通讯作者：
E. Seely;B. Walsh;M. Gerhard;Gordon H. Williams
中科院分区：
文献类型：
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作者：
E. Seely;B. Walsh;M. Gerhard;Gordon H. Williams
这项研究的目的是确定以剂量模拟绝经前状态的透皮雌二醇和阴道孕酮是否能降低绝经后妇女的血压。15名健康绝经后妇女在服用安慰剂后，每周两次，每次0.2 mg透皮给药，再在阴道内注射黄体酮300 mg/d后2周，在每一时间点，每组妇女在摄入100 mmol/d钠后进行研究。进行24小时动态血压监测，并测定血液中雌二醇、孕酮和肾素-血管紧张素-醛固酮系统(RAAS)的激素。采用单因素方差分析进行配对比较。各时间点的尿钠排泄量相似。雌激素和孕激素水平达到了与绝经前女性相似的水平。雌二醇组夜间收缩压(110+/-3 mm Hg)、舒张压(63+/-2 mm Hg)和平均压(77+/-2 mm Hg)显著低于安慰剂组(116+/-2 mm Hg)、舒张压(68+/-2 mm Hg)和平均血压(82+/-2 mm Hg)。白天的血压也有相同的趋势，但只有平均血压显著下降。未发现RAAS的激活。加入黄体酮后，血压没有进一步下降，但RAAS显着激活。因此，与通常的假设相反，服用雌二醇加或不加黄体酮不仅不会升高血压，反而会显著降低血压。这种降压作用可能是绝经前妇女高血压发病率低于绝经后妇女的原因。
The purpose of this study was to determine whether transdermal estradiol and intravaginal progesterone given in doses to mimic the premenopausal state would lower blood pressure (BP) in postmenopausal women. Fifteen healthy postmenopausal women were studied in each of 3 conditions: on placebo, after 8 weeks of transdermal estradiol 0.2 mg twice per week, and again 2 weeks after addition of intravaginal progesterone 300 mg/d. Women were studied at each point after 2 days of 100 mmol/d sodium intake. Twenty-four-hour ambulatory BP monitoring was performed, and blood was assayed for estradiol, progesterone, and hormones of the renin-angiotensin-aldosterone system (RAAS). ANOVA with pairwise comparisons was used for analysis. Urinary sodium excretion was similar at each time point. Levels of estrogen and progesterone similar to those in premenopausal women were achieved. On estradiol, nocturnal systolic BP (110+/-3 mm Hg), diastolic BP (63+/-2 mm Hg), and mean BP (77+/-2 mm Hg) fell significantly (P<0.02) compared with placebo systolic BP (116+/-2 mm Hg), diastolic BP (68+/-2 mm Hg), and mean BP (82+/-2 mm Hg). Daytime BP followed the same trend but was significantly lower only for mean BP. There was no activation of the RAAS. The addition of progesterone resulted in no further fall in BP but a significant activation of the RAAS. Thus, contrary to what is often assumed, administration of estradiol with or without progesterone not only did not raise BP but rather substantially lowered BP. This BP-lowering effect may be responsible for the lower incidence of hypertension in premenopausal than in postmenopausal women.