INFLUENCE OF MENOPAUSE ON BLOOD PRESSURE DIPPING IN WOMEN WITH METABOLIC SYNDROME: A CASE-CONTROL STUDY
https://doi.org/10.20996/1819-6446-2005-1-2-9-13
Abstract
Aim. To study if menopause influences the blood pressure (BP) decrease level during nighttime in women with metabolic syndrome.
Methods. 84 women with metabolic syndrome are examined, from them 52 are in postmenopause (average age is 56 [SD 5] years) and 32 are in premenopause (average age is 44 [5] years). Anthropomorphic measurements were made, levels of office BP and heart rate were assessed, ambulatory BP monitoring was carried out, lipids and glucose of blood serum were studied.
Results. Clinical parameters, characterizing metabolic syndrome, didn’t vary between the groups. Number of patients with insufficient decrease of BP in postmenopausal women didn’t differ significantly from the number of such women in premenopausal period (for systolic BP: 64% versus 52%, p=0,288; for diastolic BP: 34% versus 42%, p=0,469). Nevertheless, when evaluating the level of systolic BP decrease during nighttime as continuous variable, significant differences between groups are revealed (M±SEM [95% CI]: 4.4±1.5% [1.4-7.3] in postmenopausal women versus 11.3±1.7% [7.9-14.8] in premenopausal women, p=0,011).
Conclusion. Postmenopause associates with insufficient systolic BP decrease during nighttime in women with metabolic syndrome.
About the Authors
D. A. AnichkovRussian Federation
Nesterov Department of Faculty Therapy
N. A. Shostak
Russian Federation
Nesterov Department of Faculty Therapy
References
1. Edmunds E, Lip GY. Cardiovascular risk in women: the cardiologist's perspective. QJM. 2000;93(3):135-45.
2. Mercuro G, Zoncu S, Cherchi A, Rosano GM. Can menopause be considered an independent risk factor for cardiovascular disease? Ital Heart J 2001;2(10):719–27.
3. Аничков ДА, Шостак НА, Журавлева АД. Менопауза и сердечно-сосудистый риск. Рационал фармакотер кардиол. 2005;1(1): 37–42. 4. Spencer CP, Godsland IF, Stevenson JC. Is there a menopausal metabolic syndrome? Gynecol Endocrinol 1997;11:341–55.
4. Carr MC. The emergence of the metabolic syndrome with menopause. J Clin Endocrinol Metab 2003;88:2404–11.
5. Witteman JC, Grobbee DE, Kok FJ, et al. Increased risk of atherosclerosis in women after the menopause. BMJ 1989;298:642-4.
6. Wilson PW, Kannell WB, Silbershatz H, D’Agostino RB. Clustering of metabolic factors and coronary heart disease. Arch Intern Med. 1999;159:1104–1109.
7. Prisant LM. Blunted nocturnal decline in blood pressure. J Clin Hypertens (Greenwich) 2004;6:594-597.
8. Verdecchia P. Prognostic value of ambulatory blood pressure. Current evidence and clinical implications. Hypertension. 2000;35:844–851.
9. Ohkubo T, Imai Y, Tsuji I. Prognostic significance of the nocturnal decline in blood pressure in individuals with and without high 24-h blood pressure: the Ohasama study. J Hypertens 2002;20:2183- 2189.
10. Verdecchia P, Schillaci G, Gatteschi C et al. Blunted nocturnal fall in blood pressure in hypertensive women with future cardiovascular morbid events. Circulation. 1993;88(3):986–992.
11. Li B, Ijiri H, Yin D, et al. Circadian variation of blood pressure and heart rate in normotensive pre- and postmenopausal women. Nippon Ronen Igakkai Zasshi. 1997;34(10):793-7.
12. Schillaci G, Verdecchia P, Borgioni C, et al. Early cardiac changes after menopause. Hypertension. 1998;.32(4):764–769.
13. Sherwood A, Thurston R, Steffen P, et al. Blunted nighttime blood pressure dipping in postmenopausal women. Am J Hypertens. 2001;14(8 Pt 1):749–754.
14. Reaven GM. Metabolic syndrome. Pathophysiology and implications for management of cardiovascular disease. Circulation. 2002;106:286–288.
15. Grundy SM, Brewer HB Jr, Cleeman JI, et al. Definition of metabolic syndrome: Report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation 2004;109:433–8.
16. Barna I, Keszei A, Dunai A. Evaluation of Meditech ABPM-04 ambulatory blood pressure measuring device according to the British Hypertension Society protocol. Blood Press Monit. 1998;3(6): 363–368.
17. Cuspidi C, Meani S, Fusi V, et al. Is the nocturnal fall in blood pressure reduced in essential hypertensive patients with metabolic syndrome? Blood Press. 2004;13(4):230-5.
18. Harvey PJ, Wing LM, Savage J, Molloy D. The effects of different types and doses of oestrogen replacement therapy on clinic and ambulatory blood pressure and the renin-angiotensin system in normotensive postmenopausal women. J Hypertens. 1999;17(3):405-11.
19. Butkevich A, Abraham C, Phillips RA. Hormone replacement therapy and 24-hour blood pressure profile of postmenopausal women. Am J Hypertens. 2000;13(9):1039-41.
20. Zacharieva S, Kirilov G, Kalinov K, et al. Effect of different hormone replacement therapy regimens on circadian blood pressure profile and active renin in postmenopausal women. Gynecol Endocrinol. 2002;16(6):461-7.
21. Manhem K, Ahlm H, Milsom I, Svensson A. Transdermal oestrogen reduces daytime blood pressure in hypertensive women. J Hum Hypertens. 1998;12(5):323-7.
22. Mills PJ, Farag NH, Matthews S, et al. Hormone replacement therapy does not affect 24-h ambulatory blood pressure in healthy non-smoking postmenopausal women. Blood Press Monit. 2003;8(2): 57-61.
23. Vilecco AS, de Aloyso D, Radi D, et al. Plasma catecholamines in preand postmenopausal women with mild to moderate essential hypertension. J Hum Hypertens 1997;11:152–62.
24. Mercuro G, Podda A, Pitzalis L, et al. Evidence of a role of endogenous estrogen in the modulation of autonomic nervous system. Am J Cardiol 2000;85(6):787–9.
25. Nakano Y, Oshima T, Ozono R et al. Non-dipper phenomenon in essential hypertension is related to blunted nocturnal rise and fall of sympatho-vagal nervous activity and progress in retinopathy. Auton Neurosci 2001;88(3):181-186.
26. Narkiewicz K, Winnicki M, Schroeder K, et al. Relationship between muscle sympathetic nerve activity and diurnal blood pressure profile. Hypertension 2002;39:168-172.
27. Sherwood A, Steffen PR, Blumenthal JA, et al. Nighttime blood pressure dipping: the role of the sympathetic nervous system. Am J Hypertens. 2002;15:111-118.
28. Pfeilschifter J, Koditz R, Pfohl M, Schatz H. Changes in proinflammatory cytokine activity after menopause. Endocr Rev 2002;23: 90–119.
29. Cioffi M, Esposito K, Vietri M, et al. Cytokine pattern in postmenopause. Maturitas 2002;41(3):187–92.
30. von Kanel R, Jain S, Mills PJ, et al. Relation of nocturnal blood pressure dipping to cellular adhesion, inflammation and hemostasis. J Hypertens. 2004;22(11):2087-93.
31. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial. JAMA 2002;288:321–33.
32. Palatini P, Parati G. Modulation of 24-h blood pressure profiles: a new target for treatment? J Hypertens. 2005;23:1799-1801.
33. Macchiarulo C, Pieri R, Mitolo DC, Pirrelli A. Management of antihypertensive treatment with lisinopril: a chronotherapeutic approach. Eur Rev Med Pharmacol Sci 1999;3(6):269-275.
34. Esler M, Lux A, Jennings G, et al. Rilmenidine sympatholytic activity preserves mental stress, orthostatic sympathetic responses and adrenaline secretion. J Hypertens 2004;22:1529–34.
35. Anichkov DA, Shostak NA, Schastnaya OV. Comparison of rilmenidine and lisinopril on ambulatory blood pressure and plasma lipid and glucose levels in hypertensive women with metabolic syndrome. Curr Med Res Opin 2005;21(1):113–9.
Review
For citations:
Anichkov D.A., Shostak N.A. INFLUENCE OF MENOPAUSE ON BLOOD PRESSURE DIPPING IN WOMEN WITH METABOLIC SYNDROME: A CASE-CONTROL STUDY. Rational Pharmacotherapy in Cardiology. 2005;1(2):9-13. (In Russ.) https://doi.org/10.20996/1819-6446-2005-1-2-9-13