982-114 Are Hypertensive Women Being Denied Hormone Replacement Therapy?

• Published in: Journal of the American College of Cardiology 1995-02, Vol.25 (2), p.267A-267A
• Main Authors: Lip, Gregory Y.H., Beevers, Michele, Churchill, David, Beevers, Gareth
• Format: Article
• Language: English
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/0735-1097(95)92568-P

Despite the benefits of hormone replacement therapy (HRT) in relieving menopausal symptoms, there continues to be anxiety about its use in women who have high blood pressure (BP). To investigate this further we conducted a survey of HRT prescribing habits amongst clinicians. We sent 304 questionnaires to general practitioners (GPs), consultant physicians and obstetricians: a significant proportion of physicians (9%) and obstetricians (13%) did not routinely measure BP pre-HRT (X2=6.76, P=0.034) or monitor BP (24% and 10% respectively) post-HRT (X2=14.1, P=0009). All GPs said that they routinely measured BP pre-HRT. In patients with poor BP control. a large proportion of GPs, physicians and obstetricians would not prescribe HRT (54%, 42% and 30% respectively; X2=8.3, P=0.08). If a rise in BP was noted following post-HRT, most clinicians would manage this by adding or altering antihypertensive therapy. However, 10 GPs (26%), 3 physicians (7%) and 3 obstetricians (6%) said they would discontinue HRT therapy (X2=18.9, P=0.004.). A small proportion of GPs, physicians and obstetricians reported that in their opinion HRT actually raised blood pressure (20%,21% and 9% respectively) or increased the risk of venous thrombosis (38%, 36%, 10%). A small proportion of GPs also felt that HRT increased the risk of stroke (13%) and myocardial infarction (6%). This study demonstrates confusion amongst clinicians in their management of menopausal hypertensive women. A worrying proportion of clinicians also felt that HRT either increases BP, the risk of cardiovascular complications such as venous thrombosis, stroke or myocardial infarction despite evidence to the contrary. These findings suggest that hypertensive women may be denied the benefits of HRT and may also account for the low acceptance and prescribing of HRT as a means of preventing heart disease.