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Hormone replacement therapy

THE QUESTION Recent studies have suggested that hormone replacement therapy (HRT) involving a combination of estrogen and progestin may increase the risk of heart attack and stroke. Does hypertension affect the risk of HRT-associated stroke?

Hormone replacement therapyTHIS STUDY followed 13,122 post-menopausal women; 28 percent were using hormone replacement therapy at the beginning of the study, 14 percent were past users and 58 percent had never used HRT. Among the HRT users, 36 percent used estrogen alone and 59 percent used combination hormone replacement therapy. After five years, 144 women had strokes, 46 of which were fatal. The researchers found no association between HRT and stroke overall. Among the 2,256 women who had high blood pressure, however, current HRT users had more than twice the risk of stroke compared with those who never used hormone replacement therapy. The risk went up to three times for those hypertensive women who were using combination therapy.

WHO MAY BE AFFECTED BY THESE FINDINGS? Post-menopausal women with high blood pressure.

CAVEATS The results are not based on a randomized trial. In addition, hormone replacement therapy use was determined through questionnaires. Finally, the results may vary with different formulations of hormones.

BOTTOM LINE Post-menopausal women with high blood pressure may wish to avoid HRT. Those with normal blood pressure may wish to consult their physician about their risk factors for using hormone replacement therapy, such as diabetes, heart disease and breast cancer.

FIND THIS STUDY October issue of the Archives of Neurology; abstract online at http://archneur.ama-assn.org/.

LEARN MORE ABOUT the latest guidelines on hormone therapy at www.americanheart.org and http://www.fda.gov/ForConsumers/byAudience/ForWomen/default.htm.

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