"Does taking estrogen (alone)
elevate blood pressure in some women? I am 69, have
taken estrogen for 15 (or more) years after a hysterectomy.
Have had hypertension most of that time controlled
with medication. One year ago I discontinued Ogen®
after blood pressure was very high. Since then blood
pressure is down and normal. Any connection?"
There is generally considered to be an age related
rise in blood pressure in women. It does not happen
with everyone however. One study compared lay women
with nuns over a 30 year time period with regard to
how their blood pressure did . None of the women in
either group were smokers and none took birth control
pills nor did they use estrogen replacement therapy.
They found that the group of nuns did not have the
expected rise in blood pressure with age compared
to the lay women. They attributed this to the lower
stress level in the nunnerlie. It would also be possible
that diets were different but in either case this
is quite interesting.
Oral contraceptives which contain estrogen and progestin
are known to sometimes raise blood pressure. Therefore
many people assume that estrogen replacement therapy
(ERT) or hormone replacement therapy (HRT) also increases
blood pressure, however, this does not seem to be
the case at all . Most of the evidence points to a
lowering of blood pressure from ERT.
This is not to say that in your case the ERT did
not raise your blood pressure. The coincidence of
the blood pressure returning to normal when you discontinued
it is too much to ignore. You may have had a hypertensive
reaction to the specific estrogen formulation you
were on or if you were taking any other medications
during that time, there may have been interactions.
If you stopped the ERT because of another problem,
it is possible that the other problem actually lowered
your blood pressure. You need to look at many different
changes over that time period that may have influenced
your blood pressure. Finally, in the late age 60's,
your estrogen dose should have been at the level of
0.3 mg - 0.625 mg of conjugated estrogen equivalent
(0.05 mg - 0.1mg estradiol). If you were on higher
doses that could be the explanation.
Does estrogen replacement after menopause
raise blood pressure?
In healthy post menopausal women, both ERT and HRT
lower blood pressure compared with placebo. The average
reduction is systolic pressure is 7% and the reduction
of diastolic pressure is 16%.
In women who have hypertension, does ERT make the
blood pressure worse?
No. In fact it seems the opposite. Several studies
found that estrogen replacement actually lowers the
blood pressure in women with hypertension who were
on antihypertensive medicines . Interestingly, in
women who were on calcium channel blockers for their
hypertension, the blood pressure reduction was only
half that of women on other types of antihypertensives
suggesting that estrogen may function like a calcium
channel blocker in lowering hypertension. Another
randomized trial testing HRT and placebo found a reduction
in the thickness of the heart wall (a long term effect
of high blood pressure) in women taking HRT versus
placebo . While HRT decreases blood pressure on the
average in women with hypertension, not all women
respond . About 40-45% of hypertensive women will
have a lowering of blood pressure with HRT.
One study examined using injectable shots for ERT
and HRT in a group of women who had moderate hypertension
and who had discontinued their anti hypertensive medication.
They found that the ERT and HRT did not raise blood
pressure but also, the group of women receiving the
inactive placebo medication had a decrease in blood
pressure over the ninety day follow-up period. This
may have been the same phenomenum that happened in
your case, i.e., the hypertension itself improved
perhaps with the lower stress and strain of worry
about taking medications or other stress producing
life circumstances.
Are there other effects of ERT on the cardiovascular
system?
Hormone replacement has been found to decrease the
incidence of calcium deposition in the blood vessels
of the heart. In addition to the previously mentioned
decrease in heart wall thickness, it also appears
that ERT improves cardiac output and function both
at rest and with exercise. Improved cholesterol levels
are well documented from ERT with a lowering of the
low density lipids (LDL) and a raising of the high
density lipids (HDL) which is the good cholesterol
.
These benefits must be weighed against a possible
small increase in the incidence of thrombosis in women
who already have vascular disease . The large randomized
trial of HRT in women who already had coronary artery
disease suggests so far that there may be an early
adverse effect (? thrombosis) and then a later beneficial
effect of HRT on heart attacks and death . We will
have to see further data on the HERS study to know
for sure.
Is there a soy substitute for Premarin®
or Ogen® that would be as beneficial or nearly
so as the estrogen?
Plant estrogens such as those derived from soy and
red clover have effects somewhat like prescription
estrogens although not as much. Phytoestrogens commercially
available are mostly isoflavones in soy and a product
called Promensil®. Isoflavones (40 mg/day) have
a significant positive vascular effect like estrogens
but they do not improve the lipid profile as do pharmaceutical
estrogens . Athough they help the ability of the blood
vessels to remain elastic and not hardened, isoflavones
do not lower blood pressure in hypertensive patients
.
My overall conceptual model of the plant estrogens
is that they definitely have a beneficial effect on
the cardiovascular system as well as osteoporosis
but it is just not as much as HRT or ERT; I would
assess them as about 50% effective. I would recommend
taking a supplement of plant estrogens containing
at least 40 mg of isoflavones if you are not taking
ERT or HRT. |
