EFFECT OF HORMONE REPLACEMENT THERAPY ON NONINVASIVE CARDIOVASCULAR HEMODYNAMICS

Objective To determine the detailed effects of hormone replacement the rapy (HRT) on non-invasive haemodynamics, including an assessment of t he effect on the pulsatile afterload assessed in terms of the augmenta tion index and pulse-wave velocity, Design A cross-sectional study of healthy postmenopausal women using carotid and radial tonometry and pu lse-wave velocity measurements. Setting Community-based ambulatory wom en attending the menopause centre at a tertiary hospital. Patients Sev enty postmenopausal women divided into those not currently being admin istered HRT (n = 38, aged 46-72 years) and those who were being admini stered a variety of HRT (n = 32, aged 49-67 years), Methods Central ar terial pressure waveforms were measured using carotid applanation tono metry to derive the augmentation index and ejection duration, The arte rial pulse-wave velocity was assessed using paired carotid, radial and dorsalis tonometry waveforms. Results Women being administered HRT ha d a significantly lower augmentation index (20.4 +/- 8.6 versus 27.0 /- 10.2%, P= 0.005) and shorter ejection times (320 +/- 17 versus 329 +/- 18 ms, P= 0.037), There was no significant difference in brachial blood pressure (131/76 Versus 129/77 mmHg). Women being administered H RT exhibited a greater reversal in the age-related loss of amplificati on which occurs owing to arterial stiffening, This amplification betwe en central and peripheral systolic blood pressures was greater among w omen being administered HRT (5.3 +/- 6.2 versus 2.2 +/- 4.0 mmHg, P = 0.014), There was no difference in pulse-wave velocity between the two groups. Conclusions HRT appears to improve the pulsatile vascular aft erload by decreasing the augmentation of the fate systolic blood press ure, This effect is not apparent from routine brachial cuff measuremen ts, which, as a result, may underestimate haemodynamic benefits, Such effects may help to explain a portion of the improvement in cardiovasc ular morbidity found in other trials.