Type A, Race, Anger, Forgiveness, Plus Stroke, HRT, and Hydralazine - The Bad, the Good, and the To-Be-Avoided

November 14, 2003

In This Article

Increased Stroke Risk in Hypertensive Women on HRT

Women with hypertension who are taking hormone replacement therapy (HRT) are at increased risk of stroke, according to the results of a study published in the October issue of Archives of Neurology.[16] Ellen Lokkegaard, MD, PhD (Hvidovre Hospital, University of Copenhagen, Denmark) and coworkers investigated the risk of various stroke outcomes of stroke in women on HRT based primarily on estradiol-17beta (unopposed or combined with norethisterone acetate). The investigation was based on data from the Danish Nurse Study on the prevention of osteoporosis and atherosclerosis, which in 1993 sent a comprehensive questionnaire on health, lifestyle, and reproductive conditions to all female members of the Danish Nurses' Association aged > 44 years. A total of 13,122 postmenopausal women without previous cardiovascular and cerebrovascular disease of cancer were identified. In 1993, 28.0% of these women were taking HRT, 14.3% were past users, and 57.7% were never users.

During follow-up, until the end of 1998, there were 144 cases of stroke. Overall, HRT was not consistently associated with stroke, but subgroup analysis showed a significantly increased risk of stroke associated with current use of HRT vs never used among hypertensive women (hazard ratio 2.35). The risk was highest with current use of estrogen-progestin (hazard ratio 3.00) and most pronounced for ischemic stroke in current combined therapy users (hazard ratio 5.01). Normotensive women had no increased risk of stroke. Dr Lokkegaard and colleagues note that their findings need to be confirmed, but they suggest that HRT should be avoided in hypertensive women.

Commenting on the study in an editorial in the same issue of Archives of Neurology.[17] Douglas A Dulli, MD (University of Wisconsin Medical School, Madison) supports the recommendation that hypertensive women not be given HRT and extends this to women with diabetes and any risk factors for atherosclerotic vascular disease, thromboembolism, and breast cancer. Until data that define the patients and circumstances in which HRT is safe and beneficial become available, "the safe default therapy for most postmenopausal patients seems to be HRTless," he maintains.

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