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Hormone Replacement Therapy and Longitudinal Changes in Blood Pressure in Postmenopausal Women

Angelo Scuteri, MD, PhD; Angelo J.G. Bos, MD, PhD; Larry J. Brant, PhD; Laura Talbot, EdD, PhD; Edward G. Lakatta, MD; and Jerome L. Fleg, MD
[+] Article and Author Information

From Gerontology Research Center, National Institute on Aging, National Institutes of Health, and Johns Hopkins University School of Nursing, Baltimore, Maryland.


Acknowledgments: The authors thank the physicians, nurses, and physician assistants of the Baltimore Longitudinal Study on Aging staff for careful measurement of blood pressure over the years; Dr. Reubin Andres, who provided the data on blood lipids and developed the blood pressure database; and the dedicated Baltimore Longitudinal Study on Aging volunteers who participated in the study.

Requests for Single Reprints: Jerome L. Fleg, MD, Laboratory of Cardiovascular Science, Gerontology Research Center, National Institute on Aging, National Institutes of Health, 5600 Nathan Shock Drive, Baltimore, MD 21224.

Current Author Addresses: Dr. Scuteri: U.O. Geriatria, INRCA, via Cassia 1167, 00189 Rome, Italy.

Dr. Bos: Pontificia Universidade Católica do Rio Grande do Sul, Instituto de Geriatria, Avenida Ipiranga 6690, Caixa Postal 1429, Porto Alegre RS, Brazil.

Dr. Brant: Statistical Studies Section, Gerontology Research Center, National Institute on Aging, National Institutes of Health, 5600 Nathan Shock Drive, Baltimore, MD 21224.

Dr. Talbot: Johns Hopkins University, 525 North Wolfe Street, Baltimore, MD 21205.

Drs. Lakatta and Fleg: Laboratory of Cardiovascular Science, Gerontology Research Center, National Institute on Aging, National Institutes of Health, 5600 Nathan Shock Drive, Baltimore, MD 21224.

Author Contributions: Conception and design: A. Scuteri, A.J.G. Bos, E.G. Lakatta, J.L. Fleg.

Analysis and interpretation of the data: A. Scuteri, A.J.G. Bos, L.J. Brant, E.G. Lakatta, J.L. Fleg.

Drafting of the article: A. Scuteri, A.J.G. Bos, L.J. Brant, E.G. Lakatta, J.L. Fleg.

Critical revision of the article for important intellectual content: A. Scuteri, L.J. Brant, E.G. Lakatta, J.L. Fleg.

Final approval of the article: A. Scuteri, A.J.G. Bos, J.L. Fleg.

Provision of study materials or patients: A.J.G. Bos, L. Talbot.

Statistical expertise: A. Scuteri, A.J.G. Bos, L.J. Brant.

Collection and assembly of data: L. Talbot.


Ann Intern Med. 2001;135(4):229-238. doi:10.7326/0003-4819-135-4-200108210-00007
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Systolic blood pressure increases with advancing age in both sexes (12). Systolic blood pressure is lower in women younger than 40 years than in men of a similar age; after middle age, however, systolic blood pressure and diastolic blood pressure typically become higher in women than in men (35). It has been hypothesized that the steeper increase in blood pressure in women than in men after 50 years of age is related to estrogen deficiency following menopause. Whereas cross-sectional studies have reported that most hormone replacement therapy (HRT) regimens have no net effect on blood pressure (6) or may decrease blood pressure (78) in postmenopausal women, the longitudinal Postmenopausal Estrogen/Progestin Intervention (PEPI) trial found no significant differences in blood pressure changes over 3 years as a function of HRT use (9).

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Figure.
Changes in systolic blood pressure over time in users (dotted line) and nonusers (solid line) of hormone replacement therapy (HRT). Top.Bottom.dotted linesolid line

Results of a mixed-effects model predicting average changes in systolic blood pressure over time at different ages at first visit. The table below the graph shows the predicted average systolic blood pressure at first visit and the predicted average increase at different follow-up points. Predicted average increase in systolic blood pressure in HRT users ( ) and nonusers ( ) over a mean follow-up of 10 years. Average predicted changes in systolic blood pressure are expressed as percentages to take into account the difference in starting systolic blood pressure at first visit in different age groups. The final model of the mixed-effects linear regression has been used to construct the figure.

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Summary for Patients

The Effects of Hormone Replacement Therapy on Blood Pressure in Postmenopausal Women

The summary below is from the full report titled “Hormone Replacement Therapy and Longitudinal Changes in Blood Pressure in Postmenopausal Women.” It is in the 21 August 2001 issue of Annals of Internal Medicine (volume 135, pages 229-238). The authors are A Scuteri, AJG Bos, LJ Brant, L Talbot, EG Lakatta, and JL Fleg.

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