hypertension and HRT

Last edited 09/2021 and last reviewed 02/2022

• current evidence suggests that, in general, the use of HRT is not associated with an increase in blood pressure
• HRT is not contraindicated in women with hypertension and women with hypertension should be able to be prescribed HRT as long as BP levels can be controlled by antihypertensive medication
• rarely, idiosyncratic rises in blood pressure occur in women receiving HRT - thus HRT should be temporarily discontinued in women with resistant hypertension to assess the contribution of HRT to development of hypertension
• after initiation of HRT it is prudent to monitor blood pressure - 2-3 times in the first 6 months, then 6 monthly
• NICE state with respect to HRT and cardiovascular disease (3):
  • HRT:
    • does not increase cardiovascular disease risk when started in women aged under 60 years
    • does not affect the risk of dying from cardiovascular disease
      
      
  • the presence of cardiovascular risk factors is not a contraindication to HRT as long as they are optimally managed
    
    
  • the baseline risk of coronary heart disease and stroke for women around menopausal age varies from one woman to another according to the presence of cardiovascular risk factors
    
    
  • HRT with oestrogen alone is associated with no, or reduced, risk of coronary heart disease
    
    
  • HRT with oestrogen and progestogen is associated with little or no increase in the risk of coronary heart disease
    
    
• HRT should be stopped (pending investigation and treatment) if blood pressure above systolic 160 mmHg or diastolic 95 mmHg (4)

Reference:Reference:

1. Williams B, Poulter NR, Brown MJ, Davis M, McInnes GT, Potter JF, et al. Guidelines for management of hypertension: report of the fourth working party of the British Hypertension Society, 2004—BHS IV. J Hum Hypertens 2004;18: 139-85
2. Ramsey LE et al (1999). Guidelines for the management of hypertension: report of the third working party of the British Hypertension Society, 1999. J Hum Hypertens, 13, 569-92.
3. NICE (November 2015). Menopause: diagnosis and management
4. NICE BNF. Oestrogens and HRT (Accessed 17/9/2021)