Francisco J. Aranda

Surgical Menopause Increases Salt Sensitivity of Blood Pressure

Salt sensitivity of blood pressure is associated with an elevated risk of developing hypertension (HTN) and is an independent risk factor for cardiovascular disease. The prevalence of HTN increases after menopause. The aim of this study was to investigate prospectively whether the loss of ovarian hormones increases the occurrence of salt sensitivity among healthy premenopausal women. We enrolled 40 normotensive, nondiabetic women (age 47.2±3.5), undergoing hysterectomy–oophorectomy for nonneoplastic processes and not on hormone replacement, to determine the effect of changes in sodium intake on blood pressure the day before and subsequently 4 months after surgical menopause. Salt loading was achieved using a 2-L normal saline infusion and salt depletion produced by 40 mg of intravenous furosemide. A decrease >10 mm Hg in systolic blood pressure between salt loading and salt depletion was used to define salt sensitivity. Before and after menopause, salt-sensitive women exhibited higher waist/hip and waist/thigh ratios (P<0.01). Although all of the women remained normotensive, the prevalence of salt sensitivity was significantly higher after surgical menopause (21 women; 52.5%) than before (9 women; 22.5%; P=0.01), because 12 (38.7%) salt-resistant women developed salt sensitivity after menopause. In summary, we demonstrated that the prevalence of salt sensitivity doubled as early as 4 months after surgical menopause, without an associated increase in blood pressure. Epidemiological studies indicate that development of HTN may not occur until 5 to 10 years after menopause. The loss of ovarian hormones may unmask a population of women prone to salt sensitivity who, with aging, would be at higher risk for the subsequent development of HTN and cardiovascular disease.

Response to Surgical Menopause, Salt Sensitivity, and NO Bioavailability in Women

We appreciate the letter by Tsuda.1 Experimental and clinical studies have demonstrated that 17β-estradiol, via genomic and nongenomic mechanisms, increases the bioavailability of endothelium-derived NO. NO plays an important role in renal hemodynamics, sodium homeostasis, and pressure natriuresis, inducing renal vasodilatation and natriuresis.2 Gender differences exist in NO …

M.446 Assessing the real cardiovascular risk of treated essential hypertensive population. Are we doing well

In a cross-sectional, nation-wide survey, we evaluated the cardiovascular risk profile of treated essential hypertensive population through the application of the prognostic risk stratification chart proposed by the 1999 WHO / ISH committee. The study was performed at Primary Care setting by assessing clinical reports of 1038 (52.12% females) treated essential hypertensives with a mean age: 59.7 12.2 years, mean BMI: 27.4 4; mean BP:142.1 15 / 85.8 10 mmHg and mean PP: 56.3 12.5 mmHg. Antihypertensive drugs received by patients (%): One: 46.82; Two: 32.76%; Three: 13.49, and 4 or more: 5,97 %. 472 (45.5%) patients had dyslipidemia, but only 322 (31.02%) were receiving statins, and 194 (18.69%) antiplatelet drugs. Considering the levels of BP: 36.42 % had Mild; 50.4% Moderate and 13.10% severe HTN. On the other hand, 10.02% had no other risk factors (RF); 33.70 % had 1 or 2 RF; 3 or more RF or diabetes or TOD had 25.63 %, and CV complications 31.80%. According to the WHO / ISH stratification chart only 6.36 % of treated hypertensives had a Low Risk; while 35.65 % had a Medium Risk; 24.86 % High Risk and 33.14 % a Very High Risk. Despite of antihypertensive treatment most of our hypertensive patients (58%) continue to be at high CV risk indicating that to increase the reduction in their CV morbidity and mortality we need to improve our therapeutic approach by intensifying the control not only of BP levels but also the other CV risk factors.