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For example, in several studies, Premarin™ (a mixture of conjugated estrogens isolated from urine of pregnant mares) increased blood pressure [46,50,51], and various synthetic contraceptive estrogens increased the risk of hypertension [55–60].Of five women who developed hypertension after using Premarin (1.25 mg/day) for 3 months to 5 years, four became normotensive from 1 to 7 months after they cessation of therapy [46].

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Because menopause is associated with decreased synthesis of estradiol, it is likely that changes in blood pressure induced by menopause may be due in part to reductions in estradiol production.In the sections that follow, we examine the evidence for and against the involvement of female and male sex hormones in the pathogenesis of hypertension.Cross sectional [18–20], but not longitudinal [21–23], studies show a significant increase in systolic and diastolic blood pressure following the onset of menopause. [18] reported a four-fold increase in the incidence of hypertension in postmenopausal women (40% in postmenopausal women vs. In a subsequent prospective evaluation of blood pressure (conventional and ambulatory) in women who were premenopausal, perimenopausal or postmenopausal, the authors reported that postmenopausal women had a higher systolic blood pressure (4–5 mm Hg) compared with premenopausal or perimenopausal women [20].In the first, second and third trimesters of pregnancy, estradiol levels increase by 8-, 15- and 186-fold [27], respectively.In contrast, ambulatory blood pressure is lowest in the first (systolic 103±7 mm Hg) and second (systolic 101±9 mm Hg) trimesters and rises in the third trimester (systolic 111±9 mm Hg) of pregnancy [28].It should be noted that in the above studies, conjugated estrogens (Premarin) were administered orally.

Since conjugated estrogens administered via patches have been shown to have largely neutral or marginally blood pressure lowering effects, the route of administration may have a decisive role in defining the effects of conjugated estrogens on blood pressure.

In this review, we provide a discussion of the potential blood pressure regulating effects of female and male sex hormones, as well as the cellular, biochemical and molecular mechanisms by which sex hormones may modify the effects of hypertension on the cardiovascular system. Sexual dimorphism in arterial blood pressure appears in adolescence and persists throughout adulthood [1,2].

Average systolic and diastolic blood pressures in men less than 60 years-of-age are higher than in age-matched women by 6–7 and 3–5 mm Hg, respectively [3–5].

Similarly, of 27 women who developed hypertension while taking Premarin (1.25 mg/day), 13 became normotensive within 3.6 months after Premarin was discontinued, and of five women who restarted Premarin, blood pressure was again elevated within 6 weeks to 6 months [50].

In a prospective study of 160 postmenopausal women taking either Premarin (=87), development of hypertension was observed only in women taking Premarin [51].

Clinic for Endocrinology, Department of Obstetrics and Gynecology, University Hospital Zurich, Frauenklinikstrasse 10, CH-8051 Zurich, Switzerland.