激素疗法对绝经后女性平均血压及就诊间血压变异性的影响：妇女健康倡议随机对照试验的结果
The effect of hormone therapy on mean blood pressure and visit-to-visit blood pressure variability in postmenopausal women: results from the Women's Health Initiative randomized controlled trials.
作者信息
Shimbo Daichi, Wang Lu, Lamonte Michael J, Allison Matthew, Wellenius Gregory A, Bavry Anthony A, Martin Lisa W, Aragaki Aaron, Newman Jonathan D, Swica Yael, Rossouw Jacques E, Manson JoAnn E, Wassertheil-Smoller Sylvia
机构信息
aDepartment of Medicine, Columbia University Medical Center, New York, New York bDivision of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts cDepartment of Social and Preventive Medicine, School of Public Health and Health Professions, University at Buffalo - SUNY, Buffalo, New York dDepartment of Family and Preventive Medicine, University of California San Diego, San Diego, California eDepartment of Epidemiology, Brown University, Providence, Rhode Island fDepartment of Medicine, North Florida/South Georgia Veterans Health System, University of Florida, Gainesville, Florida gDivision of Cardiology, George Washington University, Washington, District of Columbia hFred Hutchinson Cancer Research Center, Seattle, Washington iCenter for Family and Community Medicine, Columbia University Medical Center, New York, New York jNational Heart, Lung, and Blood Institute, Bethesda, Maryland kDepartment of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA.
出版信息
J Hypertens. 2014 Oct;32(10):2071-81; discussion 2081. doi: 10.1097/HJH.0000000000000287.
OBJECTIVES
Mean and visit-to-visit variability (VVV) of blood pressure (BP) are associated with an increased cardiovascular disease risk. We examined the effect of hormone therapy on mean and VVV of BP in postmenopausal women from the Women's Health Initiative (WHI) randomized controlled trials.
METHODS
BP was measured at baseline and annually in the two WHI hormone therapy trials, in which 10 739 and 16 608 postmenopausal women were randomized to conjugated equine estrogens (CEEs, 0.625 mg/day) or placebo, and CEEs and medroxyprogesterone acetate (MPA, 2.5 mg/day) or placebo, respectively.
RESULTS
At the first annual visit (year 1), mean SBP was 1.04 mmHg [95% confidence interval (CI) 0.58, 1.50] and 1.35 mmHg (95% CI 0.99, 1.72) higher in the CEEs and CEEs and MPA arms, respectively, compared with the corresponding placebos. These effects remained stable after year 1. CEEs also increased the VVV of SBP (ratio of VVV in CEEs vs. placebo, 1.03; P < 0.001), whereas CEEs and MPA did not (ratio of VVV in CEEs and MPA vs. placebo, 1.01; P = 0.20). After accounting for study drug adherence, the effects of CEEs and CEEs and MPA on mean SBP increased at year 1, and the differences in the CEEs and CEEs and MPA arms vs. placebos also continued to increase after year 1. Further, both CEEs and CEEs and MPA significantly increased the VVV of SBP (ratio of VVV in CEEs vs. placebo, 1.04; P < 0.001; ratio of VVV in CEEs and MPA vs. placebo, 1.05; P < 0.001).
CONCLUSION
Among postmenopausal women, CEEs and CEEs and MPA at conventional doses increased mean and VVV of SBP.
目的
血压（BP）的均值及就诊间变异性（VVV）与心血管疾病风险增加相关。我们在女性健康倡议（WHI）随机对照试验中研究了激素治疗对绝经后女性血压均值及VVV的影响。
方法
在两项WHI激素治疗试验的基线及每年进行血压测量，其中10739名和16608名绝经后女性分别被随机分配至结合马雌激素（CEEs，0.625mg/天）或安慰剂组，以及CEEs和醋酸甲羟孕酮（MPA，2.5mg/天）或安慰剂组。
结果
在首次年度就诊（第1年）时，与相应安慰剂组相比，CEEs组和CEEs与MPA组的平均收缩压（SBP）分别高出1.04mmHg[95%置信区间（CI）0.58，1.50]和1.35mmHg（95%CI 0.99，1.72）。这些效应在第1年后保持稳定。CEEs还增加了SBP的VVV（CEEs组与安慰剂组的VVV比值为1.03；P<0.001），而CEEs与MPA组则未增加（CEEs与MPA组与安慰剂组的VVV比值为1.01；P=0.20）。在考虑研究药物依从性后，CEEs组和CEEs与MPA组在第1年时对平均SBP的影响增加，且CEEs组和CEEs与MPA组与安慰剂组之间的差异在第1年后也持续增加。此外，CEEs组和CEEs与MPA组均显著增加了SBP的VVV（CEEs组与安慰剂组的VVV比值为1.04；P<0.001；CEEs与MPA组与安慰剂组的VVV比值为1.05；P<0.001）。
结论
在绝经后女性中，常规剂量的CEEs以及CEEs与MPA增加了SBP的均值及VVV。
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