Exercise echocardiography in postmenopausal hormone users with mild systemic hypertension

Rest and exercise echocardiography (at dynamic and isometric exercise) were performed in 30 postmenopausal women (aged 54 ± 4 years) with borderline to mild hypertension. They were then divided into 2 groups: 17 women who started oral hormone replacement therapy (0.625 mg/day conjugated estrogens or 2 mg/day estradiol) and a control group of 13 nonusers. After 6 to 9 months, a second echocardiography was performed in 26 women (4 withdrew). There were only a few changes in values obtained in the 12 controls at the end of follow-up compared with baseline. Primarily, these changes included a slight decrease in systolic blood pressure at rest and on exercise. Several significant morphologic and hemodynamic alterations appeared in 14 hormone users. Left ventricular cavity dimensions and mass became smaller: mean end-diastolic diameter decreased from 45.9 ± 3 mm at baseline to 44.4 ± 3 mm at study termination (p = 0.007). The corresponding values for end-systolic diameter were 25.8 ± 4 mm and 23.9 ± 4 mm (p = 0.006); for left atrium diameter, it was 34.5 ± 4 mm and 32.5 ± 4 mm (p = 0.001); for left ventricular wall width, it was 19.9 ± 2 mm and 19.3 ± 2 mm (p = 0.02); for left ventricular mass, it was 197 ± 28 g and 179 ± 32 g (p = 0.006). The resting aortic blood flow velocity and acceleration increased: 119 ± 18 cm/s before therapy versus 129 ± 23 cm/s while on hormone substitution (p = 0.04), and 13.6 ± 3 m/s2 versus 16.5 ± 4 m/s2 (p = 0.008), respectively. Mean rest to peak exercise systolic blood pressure difference became smaller after hormones: 39 ± 19 mm Hg versus 28 ± 13 mm Hg (p = 0.03) during dynamic exercise, and 43 ± 22 mm Hg versus 25 ± 13 mm Hg (p = 0.004) during isometric exercise. The above data probably indicate that with hormone replacement therapy, there is an improvement in cardiac function both at rest and during exercise.