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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In summary, oral estrogens are often prescribed to relieve menopause symptoms. They should not be used in women who have had breast cancer, thrombophlebitis, hypertension, gallstones, or undiagnosed abnormal genital bleeding. Hormone replacement therapy has proven to be very useful in preventing osteoporosis, hot flashes, night sweats, and vaginal dryness. More information is needed before they should be recommended for the prevention of heart disease in postmenopausal women.
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PMID:Estrogen replacement therapy. 185 17

The purpose of this study, designed as an open multicenter trial, was to test the antihypertensive efficacy, patient acceptability, and side effects of long-term treatment with slow-release nifedipine in a large population. The drug was studied in 330 outpatients with essential hypertension, WHO stage 1-2, recruited in 20 hospital centers. After washout period was completed, nifedipine (20 mg bid) was given for 1 month (phase 1). Then, the treatment was extended for 4 months (phase 2) with variable doses (range 20-80 mg daily). No other antihypertensive drugs were administered during phase 1. However diuretics, beta blockers, or captopril were added to nifedipine during phase 2 in 11 patients. Seventy patients did not meet criteria for inclusion at washout. During phase 1 and 2, 66 additional patients were excluded due to side effects, the need of other antihypertensive drugs, or non-compliance. Systolic blood pressure significantly lowered (10% or more) in 84% patients in phase 1 and in 76% in phase 2. No responders were 6.1% and 3.6%, respectively. Diastolic blood pressure was normalized in 60% of patients after 5 months of therapy. Effects on blood pressure were equal in young patients and in the elderly, but a minimal rise in heart rate was recorded in younger patients. At least one side effect occurred in 46.6% patients, mainly headache (15.4%), hot flashes (13.3%), ankle edema (12.8%), or palpitation (6.6%). Sixteen patients (8.2%) were obliged to stop nifedipine treatment due to the severity of the side effects. This trial confirms the efficacy of nifedipine in hypertension, both in young and in aged patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Long-term therapy with slow-release nifedipine in essential hypertension. 207 4

The purpose of this study was to evaluate the effect of clonidine--an alpha 2-adrenergic agonist--and naloxone--an opiate antagonist--on pituitary hormone release. The study involved 43 women: 20 menopausal women, 9 untreated women with ACTH-dependent Cushing's disease, and 14 healthy women. Serum GH, ACTH, LH, FSH, TSH, cortisol, and plasma beta-endorphin concentrations were measured with RIA methods. A significant increase in GH and a significant decrease in ACTH and in cortisol was observed after clonidine injection in healthy women. Clonidine caused a significant decrease in LH concentration in the luteal phase of the menstrual cycle. However, naloxone induced the opposite effect on pituitary hormone release. In Cushing's disease, ACTH significantly decreased in response to clonidine. In postmenopausal women with hypertension a decrease in blood pressure, a marked decrease in the number of hot flashes, as well as a diminution in amplitude and frequency of LH pulsatility was found. Conclusions are as follows: (1) Clonidine may be useful in the treatment of hypertensive menopausal women; and (2) a diminution in ACTH, beta-endorphin, and cortisol release in response to clonidine was observed in Cushing's disease.
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PMID:The effect of clonidine on pituitary hormone secretion in physiological and pathological states. 245 86

In this double-blind cross-over study 16 patients with mild-to-moderate hypertension were treated with placebo and the dihydropyridine derivative, isradipine 5-10 mg twice daily. In the supine position isradipine reduced systolic (-18 mm Hg; p less than 0.002) and diastolic (-15 mm Hg; p less than 0.001) pressures, while heart rate was not changed; in the standing position, systolic (-15 mm Hg; p less than 0.002) and diastolic (-14 mm Hg; p less than 0.001) pressures decreased, whereas heart rate increased (+6 bpm; p less than 0.05). Body weight and lower leg volumes remained unaltered, suggesting that isradipine did not cause fluid retention. On IS plasma angiotensin I (+40 pg/ml), angiotensin II (+ 14 pg/ml), and aldosterone (+4.1 ng/dl) rose. The intracellular Na+ and K+ concentrations and the transmembrane cation transport activities (Na+-K+ pump, Na+-K+ cotransport, Na+-Li+ countertransport), measured ex vivo in the erythrocytes of eight male patients, were not significantly influenced by isradipine. Hot flushes and facial erythema occurred more frequently (p less than 0.05) on isradipine than on placebo. In conclusion, the new calcium entry blocker isradipine at a dose of 5-10 mg twice daily lowers blood pressure and is well tolerated in most patients with essential hypertension.
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PMID:Effects of the new calcium entry blocker isradipine (PN 200-110) in essential hypertension. 246 57

Indications and complications of estrogen replacement therapy are discussed in this edited transcription of a conference held at the UCLA School of Medicine. Although many of the symptoms of loss of ovarian function can be corrected by estrogen replacement therapy, several potentially harmful side effects are associated with the administration of estrogen. Hot flashes, the most common menopausal symptom for which women seek treatment, may continue over extended periods of time and the loss of ovarian feedback signals. Several types of evidence indicate that hot flashes are centrally rather than peripherally mediated disturbances, and it now appears that the hypothalamic factors which stimulate pulsatile release of luteinizing hormone play an integral role in initiation of hot flashes. The fact that the extent of estrogen deficiency differs among postmenopausal women may explain why all women do not have hot flashes. The effects of body size on estrogen production and plasma protein binding appear to be significant variables modulating the extent of estrogen deficiency and hypothalamic function. Other studies suggest that calcitonin and gonadal steroids are linked in the pathogenesis and treatment of osteoporosis, but the mechanism of action of estrogen replacement therapy in the treatment of osteoporosis has not been elucidated. Most investigations have failed to show the presence of estrogen receptors in bone. It is likely that the term osteoporosis includes heterogeneous skeletal disorders and that both sex hormones and calcemic hormones are important in pathogenesis. Further research is required on the possible effect of estrogen replacement therapy in decreasing relative risk of arteriosclerotic heart disease. Vaginal atrophy is an accepted indication for estrogen replacement, but its use for skin indications should not be recommended until a beneficial cosmetic effect is shown. Complications of estrogen replacement include endometrial cancer, breast cancer, hypertension, hyperlipidemia, and gallbladder disease, the latter 3 apparently resulting from hepatic action of estrogen replacement therapy. Because of the enhanced hepatic action of orally administered estrogen, other routes of administration are being explored. Additional research is needed to define the risk-benefit ratio of estrogen replacement therapy.
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PMID:Estrogen replacement therapy: indications and complications. 682 55

The use of estrogen replacement therapy in postmenopausal women is under close scrutiny. The indications and side effects of replacement therapy are reviewed, and recommendations regarding its use are made. Hot flashes, atrophy of the vaginal epithelium, and prevention of osteoporosis have been established as indications for estrogen replacement therapy. Prevention of cardiovascular disease, aging changes of skin, and the occurrence of mental illness have also been suggested as indications, but beneficial effects of estrogen replacement therapy for these problems have not been clearly established. Studies have shown that side effects of estrogen replacement therapy include endometrial cancer, hypertension, gallbladder disease, and angina pectoris. Breast cancer may also be a risk factor, but a consensus of opinion has not been established. Pulmonary embolism, cerebral vascular accident, or myocardial infarction has not been associated with estrogen replacement therapy. The use of progesterone with estrogen replacement therapy has been shown to reduce the occurrence rate of endometrial carcinoma, but it does not prevent all the actions of estrogen. Oral administration of estrogen is the preferred route despite misgivings about portal absorption and liver metabolism. Further studies must examine this question. Various agents have been shown to be effective in treating some climacteric symptoms. These include progesterone for hot flashes and calcium for the prevention of osteoporosis. Other agents may also be effective but have not been tested critically.
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PMID:Estrogen replacement therapy. 702 79

The symptomatic postmenopausal woman with breast cancer presents the clinician with a difficult task with respect to hormone replacement therapy (HRT). All of the published meta-analyses have been consistent in showing that there is a slightly increased risk of developing breast cancer in those patients using postmenopausal estrogens for greater than 10 years. However, there have been no published placebo-controlled clinical trials on the effects of HRT in women with a history of breast cancer. Quality of life must be balanced against the theoretical risk of tumor promotion. Assessment of osteoporotic and cardiac risk factors (i.e., smoking, hypertension, family history, hyperlipidemia) should influence the decision. Valid alternatives to estrogen replacement include low-dose progesterones such as Bellergal or vitamin E for hot flashes, and biphosphonates, calcium, anabolic steroids, and calcitonin for osteoporosis.
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PMID:The management of menopausal symptoms in women with breast cancer. 761 Jun 43

To obtain information to guide future health care planning, data from government and other sources on the demographic and medical characteristics of menopausal Taiwanese women were reviewed. The average age at menopause, according to a 1995-96 study of 386 menopausal women in Taipei, is 49.5 +or- 2.3 years. In 1994, women aged 50 years and over comprised 18.3% of Taiwan's female population and 8.9% of the total population. 68% of menopausal women in the 1995-96 study reported lower back pain; other common symptoms included fatigue (59%), decreased memory (55%), vaginal dryness (50%), hot flashes (49%), insomnia (46%), loss of libido (46%), dry skin (41%), and depression (40%). After menopause, the prevalence of hypertension and coronary heart disease becomes higher among women than men. In addition, bone mineral density decreases markedly and 19.8% of women 65 years of age and over have experienced vertebral fractures. About 60% of malignant neoplasms diagnosed in 1992 involved women aged 50 years and older. By age 60 years, women's risk of cancer begins to increase substantially. An estimated 80% of Taiwanese women initiate hormone replacement therapy for relief of menopausal symptoms, prevention of cardiovascular disease, and prevention and treatment of osteoporosis. Since 30% of menopausal women in Taiwan are currently widowed or unmarried, there is a need to design programs that offer psychosocial support as well as comprehensive medical care.
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PMID:Demographic characteristics and medical aspects of menopausal women in Taiwan. 934 80

While conventional hormone replacement therapy provides certain benefits, it is not without significant risks. Estriol has been found to provide some of the protection without the risks associated with stronger estrogens. Depending upon the situation, estriol may exert either agonistic or antagonistic effects on estrogen. Estriol appears to be effective at controlling symptoms of menopause, including hot flashes, insomnia, vaginal dryness, and frequent urinary tract infections. Results of research on its bone-density-maintaining effects have been contradictory, with the most promising results coming from Japanese studies. Estriol's effect on cardiac risk factors has also been somewhat equivocal; however, unlike conventional estrogen prescriptions, it does not seem to contribute to hypertension. Although estriol appears to be much safer than estrone or estradiol, its continuous use in high doses may have a stimulatory effect on both breast and endometrial tissue.
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PMID:Estriol: safety and efficacy. 957 46

Sleep problems (i.e., insomnia) affect midlife women as they approach and pass through menopause at rates higher than at most other stages of life. The purpose of this article is to critically review what is known about insomnia (perceived poor sleep) and physiologically assessed sleep, as well as sleep-related disordered breathing (SDB), in women according to menopausal status and the role of hypothalamic-pituitary-ovarian (HPO) hormones. Self-report evidence that sleep difficulties are related to the hormonal changes of menopause is mixed. Data from studies in which sleep was physiologically measured reveal that sleep problems appear corequisite with hot flashes and sweats. Results are difficult to compare across studies because of varying methodologies in how sleep quality and patterns were assessed and how age cohorts and menopausal status were defined. The risk of SDB increases with age, although women are less susceptible at any age than men. As with men, snoring, obesity, and high blood pressure are clear risk factors. Some women may be underdiagnosed for SDB, as they have somewhat different symptom manifestations than men. Usually, frank apnea is not as evident. Primary care clinicians should be mindful of the potential for SDB in women who are obese, have high blood pressure, are cognizant of snoring, and report morning headaches and excessive daytime sleepiness. Improved care will result from consistently incorporating sleep insomnia assessments into practice as a basis for referring to sleep centers as necessary or prescribing sleep-enhancing behavioral and pharmacological treatments.
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PMID:Sleep disturbance in menopause. 1074 14


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