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| |  APS MEETING: Estrogen Replacement Lowers Blood Pressure Of Older Women With Hypertension CHAPEL HILL, NC -- March 17, 1999 -- New research at the University of North Carolina at Chapel Hill ties estrogen replacement to reducing blood pressure in older women with hypertension. The reductions, observed for the first time under both stressful and restful situations, may help explain why fewer deaths from heart disease and stroke occur among women who opt for hormone replacement therapy after menopause. "It has been unclear if this was a result of the estrogen itself or because these women tend to see their doctors more often and possibly get better treatment, or smoke less, eat better, or exercise more," said Dr. Kathleen Light, professor of psychiatry at UNC-CH School of Medicine. The results were reported today at the American Psychosomatic Society annual meeting in Vancouver, B.C. Women with hypertension who took estrogen for six months showed an average blood pressure reduction of 5-12 points during high and low experimental stress conditions. The test conditions included a computerised problem-solving task and a speech stressor test, in which the study participants told of their actions and emotional reactions to personally troubling events. "This beneficial drop in pressure was as great when the women were talking about events that had made them upset and angry and during mental challenges as when they were resting," Light said. She explained that the drop was due to a relaxation, or dilation, of their blood vessels. "When vessels throughout the body constrict, the workload on the heart increases," Light said. "But if the heart's own vessels also constrict, the heart can't always get enough oxygen from the blood to function well." She added that anger, anxiety and meeting mental challenges can increase blood pressure and blood vessel constriction. "High blood pressure within a constricted vessel makes it more likely that a clot or lesion in the vessels can stop blood flow through it entirely, resulting in some cases in a heart attack or stroke," she said. During 24-hour monitoring at home, blood pressure levels also tended to be 3-6 mmHg lower after estrogen treatment than before. However, women taking a look-alike placebo pill showed no improvement and in fact tended to increase their blood pressure. These findings suggest that estrogen treatment itself is likely to be directly beneficial for postmenopausal women at risk for heart disease and stroke. But Light pointed out that these women were too few and were not studied long enough to definitively prove that estrogen replacement reduces cardiac deaths. She said such a test is underway in the large multicentre Women's Health Initiative, which includes the UNC-CH study team. Light, the director of UNC-CH's Stress and Health Research Program, said study participants with a prior hysterectomy took only one estrogen pill per day -- Premarin or placebo -- for six months. But to minimise any risk of uterine problems that might be associated with hormone replacement, other women took estrogen plus an extra pill, either progesterone or another placebo pill, for 10 days each month.
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