Effects of oral conjugated equine estrogens with or without medroxyprogesterone acetate on incident hypertension in the Women's Health Initiative hormone therapy trials.

Autor:	Swica Y; Department of Medicine, Division of Family and Community Medicine, New York, NY., Warren MP; Department of Obstetrics and Gynecology and Medicine, New York, NY., Manson JE; Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA., Aragaki AK; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA., Bassuk SS; Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA., Shimbo D; Department of Medicine, Division of Cardiology, New York, NY., Kaunitz A; Department of Obstetrics and Gynecology, Jacksonville, FL., Rossouw J; Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD., Stefanick ML; Stanford Prevention Research Center, Stanford Women and Sex Differences in Medicine (WSDM) Center Stanford University School of Medicine, Stanford, CA., Womack CR; Department of Preventive Medicine and Medicine, University of Tennessee Health Sciences Center, Memphis, TN.
Jazyk:	angličtina
Zdroj:	Menopause (New York, N.Y.) [Menopause] 2018 Jul; Vol. 25 (7), pp. 753-761.
DOI:	10.1097/GME.0000000000001067
Abstrakt:	Objective: The aim of the study was to determine the effect of menopausal hormone therapy on incident hypertension in the two Women's Health Initiative hormone therapy trials and in extended postintervention follow-up. Methods: A total of 27,347 postmenopausal women aged 50 to 79 years were enrolled at 40 US centers. This analysis includes the subsample of 18,015 women who did not report hypertension at baseline and were not taking antihypertensive medication. Women with an intact uterus received conjugated equine estrogens (CEE; 0.625 mg/d) plus medroxyprogesterone acetate (MPA; 2.5 mg/d) (n = 5,994) or placebo (n = 5,679). Women with prior hysterectomy received CEE alone (0.625 mg/d) (n = 3,108) or placebo (n = 3,234). The intervention lasted a median of 5.6 years in the CEE plus MPA trial and 7.2 years in the CEE-alone trial with 13 years of cumulative follow-up until September 30, 2010. The primary outcome for these analyses was self-report of a new diagnosis of hypertension and/or high blood pressure requiring treatment with medication. Results: During the CEE and CEE plus MPA intervention phase, the rate of incident hypertension was 18% higher for intervention than for placebo (CEE: hazard ratio [HR], 1.18; 95% CI, 1.09-1.29; CEE plus MPA: HR, 1.18; 95% CI, 1.09-1.27). This effect dissipated postintervention in both trials (CEE: HR, 1.06; 95% CI, 0.94-1.20; CEE plus MPA: HR, 1.02; 95% CI, 0.94-1.10). Conclusions: CEE (0.625 mg/d) administered orally, with or without MPA, is associated with an increased risk of hypertension in older postmenopausal women. Whether lower doses, different estrogen formulations, or transdermal route of administration offer lower risks warrant further study.
Databáze:	MEDLINE
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