Angiotensin II type 1 receptor blockade to control blood pressure in postmenopausal women: Influence of hormone replacement therapy

Abstract

Background. Hypertension is twice as common in post-menopausal than in premenopausal women. This study evaluated the effectiveness of a blockade of the renin-angiotensin-aldosterone system (RAAS) with candesartan cilexetil (CC) to control blood pressure (BP) in hypertensive menopausal women, and the influence of hormone replacement therapy (HRT). Methods. This was designed as a prospective, open-label and non-comparative study. Included were 618 hypertensive menopausal women grade I/II according to the Sixth Report of the Joint National Committee (VI-JNC), with an average age 52 ± 4.7 years (95% CI 52.3-53.0) and with a last menstrual period (LMP) at least one year before. BP was determined by measurement in four visits during six months of follow-up, according to the recommendations of the OMS/SIH. Optimal control of BP was considered as BP <140/90 mm Hg. Results. A statistically significant decrease in systolic (SBP; 19.9 ± 11.2) and diastolic (DBP; 11.5 ± 7.3) blood pressure mm Hg values was observed (P < 0.01). The control of BP increased significantly over time to 61.2% (P < 0.01). In multivariate analysis, only age was associated with control of BP (β = -0.062; P = 0.004). Of the women not controlled in the second visit, 12.5 mg of hydrochlorothiazide (HCTZ) were added to 31.5% (N = 122), with 80% more BP control achieved in visit 3 than in the non-supplement group (OR = 1.8; 95% CI 1.04-3.05; P < 0.03). One hundred and three (16.7%) patients were receiving HRT for 2.01 ± 2.23 years (95% CI 1.55-2.46). HRT did not affect the control of BP. No severe adverse reactions were reported. Conclusions. Candesartan cilexetil significantly reduced SBP and DBP and increased control (61.2%) of BP in hypertensive menopausal women. Only age had an inverse association with control of BP. In this study, HRT did not affect the control of BP.