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

Estrogens are very successful in premenopausal and postmenopausal therapy. Synthetic estrogens, such as ethinyl estradiol and mestranol, are used in hormonal contraception, while natural estrogen are used for treatment during and after climaterium. It seems that the major difference between the action of synthetic and of natural estrogens is at the level of the venous endotelial system. It has been proven that the use of synthetic estrogen used in hormonal contraception can increase the risk of thrombotic accidents, and that the risk is even greater in women over 40, or in smokers. Synthetic estrogens can alter lipid metabolism and blood coagulation, and often lead to hypertension. Such complications are not reported with the use of natural estrogens traditionally used in menopausal and postmenopausal therapy.
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PMID:[Estrogen therapy for the climateric and thromboembolic risk]. 739 92

Various aspects of climacteric treatment with natural human estrogens are discussed. Estradiol, estradiol valerate, estron sulfate, or estriol are used separately or together in various preparations to treat the symptoms of approaching menopause. Estrogen treatment causes proliferation of the endometrium and causes a decrease in LHRH, FSH, and LH secretion. Treatment can take the form of continuous or cyclic treatment with estrogens alone, or sequential estrogne/gestagen preparations can be used. Ovarian function decreases as menopause approaches and results in the cessation of ovulation. Then the hypolutein phase begins, during which the secretion of progesterone is reduced and menstrual bleeding irregularities begin to occur. Eventually, estrogen production decreases so much that menstruation ceases completely, and symptoms such as heat flashes are experienced. Women who want treatment for climacteric symptoms but who want no regular menstrual bleeding can be administered low doses of pure estrogen. Regular abrasio control of endometrial development should be performed, however. Pure estrogen treatment can also be used in the case of hysterectomized women. Otherwise, a sequential treatment is generally indicated. Possible side effects of estrogen substitution therapy are changes in the genitalia, breasts, menstrual bleeding, blood pressure, and weight. There is also an indication that estrogen use can induce endometrial cancer. Besides the definite contraindication of endometrial cancer, relative contraindications of estrogen therapy include breast cancer, reduced liver function, thromboembolic disease, and serious hypertension. Estrogen therapy is to be used to solve acute climacteric symptoms; women should be well informed about possible side effects and that the therapy is no panacea for all menopausal problems.
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PMID:[Peroral treatment with natural human estrogens in the climacteric]. 744 54

Schering AG (manufacturer of a monophasic oral contraceptive [OC] containing 75 mcg gestodene plus 30 mcg ethinyl estradiol) in Berlin, Germany, conducted a retrospective analysis of blood pressure measurements from 4 clinical trials of the contraceptive efficacy and safety of monophasic gestodene to examine gestodene's effect on blood pressure and the incidence of OC-related blood pressure/ hypertension. (OC-related blood pressure/hypertension is defined as: women with neither history of hypertension nor elevated blood pressure before OC use develop increased blood pressure or hypertension that is reversible once OC use ceases.) The clinical trials recorded the blood pressure of 1930 women for up to 24 cycles. Most women (89.9%) experienced no change in their blood pressure during OC use. 97 women (5%) experienced an increase in blood pressure. 26 women (1.35%) had OC-elevated blood pressure/hypertension. Four women left the trials due to hypertension. 67 women (3.5%) who had elevated blood pressure before OC use attained normalization of blood pressure during OC use. These results show that the gestodene-containing OC had an insignificant effect on blood pressure and that elevated blood pressure rarely occurred.
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PMID:The effect on blood pressure of a monophasic oral contraceptive containing ethinylestradiol and gestodene. 755 72

Vasoprotective drugs decrease the vulnerability of blood vessels to cardiovascular risk factors such as hypertension and hypercholesterolemia. Mechanistic treatment end-points of hypertension (normalization of endovascular pressure) may not correct nonhypertensive components of the pathobiology of hypertension. Estrogen replacement therapy, antihypertensive treatment with angiotensin-converting enzyme inhibitors, and manipulations of nitric oxide metabolism may have beneficial effects on vessels in the absence of blood pressure normalization. Estrogens and L-arginine, the precursor of nitric oxide, can partly correct impaired endothelium-dependent vasodilation, a pathophysiologic hallmark of hypertensive states. Angiotensin-converting enzyme inhibitors preserve endothelium-dependent vasodilation and protect arteries against the atherogenic effects of hypercholesterolemia by a non-hypolipidemic, non-hypotensive mechanism.
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PMID:Vasoprotection and antihypertensive therapy. 760 51

Postmenopausal women are 2-3 times more likely to have a heart attack than premenopausal women. According to the results of the Framingham study, angina is one of the main manifestations of coronary heart disease in women, whereas myocardial infarction and sudden death are more frequent in men. Cigarette smoking, high blood pressure and hypercholesterolemia are major risk factors for coronary heart disease in both men and women, while diabetes mellitus and hypo-high-density lipoproteinemia are more clearly associated with cardiovascular disease in women than in men. Endogenous and exogenous hormones may be a major determinant of the cardiovascular risk in women. Premenopausal women have a considerably lower incidence of coronary heart disease than postmenopausal women, and estrogen therapy is associated with a reduced risk in the latter. Part of this protective effect seems to be due to the influence of estrogen therapy on lipoprotein metabolism, i.e. a decrease in LDL cholesterol and an increase in HDL cholesterol. Progestins, to an extent which depends on their androgenic potency, have the opposite effects. A large study (the Postmenpausal Estrogen Progestin Intervention Trial) has been launched to test the effect of the estrogen-progestin combination on various cardiovascular risk factors.
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PMID:Estrogens and progestins in postmenopausal women: influence on lipid parameters and cardiovascular risk. 772 Dec 54

Ethinyl estradiol is the only estrogen form used in low-dose oral contraceptive (OC) pills. Progestogenic compounds used in OCs include norethindrone, norethindrone acetate, ethynodiol diacetate, norgestrel, levonorgestrel, and norethynodrel. The newest third generation progestins are desogestrel and norgestimate. The most important benefits associated with OC use are a decrease in benign breast disease, less incidence of ovarian and endometrial cancers, and a decrease in the incidence of pelvic inflammatory disease. The most serious risks to OC users who are over age 35 and smoke are deep vein thrombosis, pulmonary embolus, retinal thrombosis, or cardiovascular disease. Other risk factors for cardiovascular disease include obesity, diabetes, hypertension, increased serum cholesterol, and a family history of premature myocardial infarction. All users should have blood pressure checks 3 and 6 months after commencing pill use. OC preparations cause an increase in total cholesterol, triglycerides, low density lipoprotein (LDL), very low density lipoprotein (VLDL), and a decrease in high density lipoprotein (HDL), but norgestimate may actually increase HDL levels. Preparations with levonorgestrel may produce the greatest decrease in glucose tolerance, while those with 35 mcg of ethinyl estradiol and 0.5 mg of norethindrone have the least effect. OCs do not increase the risk of developing breast cancer, but can stimulate the growth of breast cancer once it has occurred. The incidence of gallbladder disease is increased slightly in OC using women who are predisposed. Hepatocellular adenomas are associated with combined OC use. Underweight women are more prone to side effects and need a very low potency preparation. A common problem encountered by patients on OCs is amenorrhea. This usually resolves after 3 cycles. Breakthrough bleeding is also very common. Post-pill amenorrhea is frequently found after stopping OCs. Combined oral contraceptives are a safe and effective contraceptive method for most women throughout their reproductive years.
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PMID:Combined oral contraceptive pills: a brief review. 783 35

Although an association between oral contraceptives (OCs) and arterial hypertension has been well-documented, most studies have found only mild or moderate hypertension with reversal to normal levels 3 months after OC discontinuation. This paper presents two cases in which young women developed severe left ventricular hypertrophy and renal failure due to OC-induced malignization of hypertension. The first patient, a 23-year-old, was admitted to the hospital with a 3-day history of headache, mental confusion, and aggressiveness. 6 months before presentation, severe arterial hypertension had been diagnosed. At that time, she was advised to discontinue OCs (30 mcg of ethinyl estradiol and 150 mcg of levonorgestrel), which she had been taking for a year; she did not comply with this directive. The second patient, 21 years old, was admitted with accelerating hypertension. She had initiated OC use (30 mg of ethinyl estradiol and 150 mcg of levonorgestrel) 6 months earlier. 3 months after starting OC use, she developed headache and fatigue. Both women had a hemorrhagic cerebral accident as a complication of malignant hypertension. All neurologic, renal, and cardiovascular complications were reversible after OC discontinuation. OC-related malignant hypertension can be averted through effective control of blood pressure in OC users.
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PMID:Cardiac and neurologic complications in malignant hypertension due to oral contraceptive use. 786 96

In China, family planning specialists recruited 764 women, 22-40 years old, from 4 hospitals in Shanghai for a study to compare the effects of oral contraceptives (OCs) and hormonal contraceptive implants (Norplant) on blood pressure changes with those not using hormonal contraception. They followed the women for 48 weeks. The experimental groups comprised 238 women using the OC (Chinese Pill No. 1 containing 35 mcg ethinyl estradiol + 600 mcg norethisterone) and 267 using Norplant (216 mg levonorgestrel released over 5 years). The control group included 259 women accepting a stainless steel ring IUD. No woman in any group discontinued contraceptive use due to hypertension. OC users had higher increases in diastolic blood pressure than IUD users. The increases were 1.8 mm Hg at 12 weeks, 2.1 mm Hg at 24 weeks, 2.3 mm Hg at 36 weeks, and 1.9 mm Hg at 48 weeks (p .05 for all but 36 weeks; p .01 for 36 weeks). At the end of 48 weeks, when the researchers adjusted for confounding variables, the diastolic blood pressure increased by about 1 mm Hg with OC use (p .05). This increase is clinically insignificant, however. OC users also had higher increases in systolic blood pressure than IUD users (1.3, 1.7, 1.5, and 1.3 mm Hg, respectively), but the increases were not significant. The Norplant implant did not change either diastolic or systolic blood pressure. Women's age, obesity, and family history of hypertension were associated with an increase in blood pressure. These variables did not have any interactive effects on blood pressure changes with hormonal contraceptive use, however. These findings show that low estrogen OC use slightly increases diastolic blood pressure and that Norplant implants have no effect on systolic and diastolic blood pressures.
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PMID:Blood pressure changes and hormonal contraceptives. 795 12

The role of EDRF in the modulation of blood pressure and vascular reactivity in estrogen-treated rats was investigated both in vivo and in vitro studies. In vivo, long-term subcutaneous injection of ethinyl estradiol (EE2, 0.2 micrograms/day, s.c.) for 6 weeks significantly induced an elevation of systolic blood pressure from 117.1 +/- 2.7 to 129.9 +/- 3.6 mmHg. In vitro, the endothelium-dependent relaxation of ACh (10(-8)-10(-5) M) in intact aortic rings from EE2-treated rats was significantly blunted compared with normal control rats. Meanwhile, the contractile responses to PE (10(-8)-10(-5) M) was no difference between intact and denuded aortic rings from EE2-treated rats. The results indicate that the reduction of vasodilator response to ACh and the loss of enhanced contractile responses to PE in denuded rings may be due to altered endothelial function after long-term treatment with EE2. Furthermore, the high potassium (12.5-62.5 mM) induced-contraction and nitroglycerin (3 x 10(-8)-3 x 10(-6) M) induced-relaxation were not different between EE2 and control groups. These results indicate that the function of vascular smooth muscle did not alter after long-term treatment with EE2. In conclusion, the alteration of function of endothelium may play an important role in the modulation of estrogen-induced mild hypertension.
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PMID:The role of EDRF in the modulation of blood pressure and vascular reactivity in estrogen-treated rats. 795 10

Elevated insulin concentrations are frequently found in both men and women with coronary heart disease (CHD), and are likely to be due to insulin resistance. Hyperinsulinaemia may increase CHD risk by directly promoting atherogenesis, and insulin propeptides may also be important in this respect. However, increased insulin concentrations may adversely affect several other CHD risk factors, and it has been postulated that insulin resistance is a pivotal metabolic disturbance in a constellation of CHD risk factors. There is an association between hyperinsulinaemia and hypertension, although it is not known if this association is direct. Increased insulin concentrations are also associated with high triglycerides, low HDL or HDL2 concentrations, and increased small dense LDL. Obesity is also associated with insulin resistance, and it is the central or android body fat distribution which correlates with these metabolic disturbances. All these associated factors constitute a distinct syndrome--the insulin resistance syndrome--which is a frequent finding in patients with CHD, including microvascular angina. It is possible that the adverse associations of insulin resistance and dyslipidaemia are mediated through increased nonesterified fatty acid flux. Increased insulin levels are also associated with increases in the anti-fibrinolytic factor, plasminogen activator inhibitor-I (PAI-I). Whilst increased insulin levels are typically associated with insulin resistance, reduced hepatic insulin uptake may also be important. We now have techniques which can quantitate insulin secretion, hepatic uptake and release, elimination, and resistance. The menopause has appreciable effect on insulin and glucose metabolism. Estrogen and progesterone augment pancreatic insulin secretion, but the former reduces insulin resistance whilst the latter increases it.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:HRT mechanisms of action: carbohydrates. 819 41


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