Combo HT curbs hot flashes, cuts blood pressure: drospirenone has antialdosterone effects.(News)

WASHINGTON -- The combination of drospirenone (a progestin with antialdosterone effects) and 17-[beta]-estradiol as hormone therapy for hypertensive postmenopausal women not only reduces their hot flashes, but lowers their blood pressure as well, according to a poster presented at the annual meeting of the American College of Obstetricians and Gynecologists.

Treatment with the combination of drospirenone and 17-[beta]-estradiol for an 8-week period produced significant reductions in systolic and diastolic 24-hour ambulatory and clinic blood pressure at 2- and 3-mg doses of drospirenone, reported Dr. William B. White, professor of medicine at the University of Connecticut, Farmington.

Drospirenone plus estradiol has been used for the treatment of menopausal symptoms and is Food and Drug Administration-approved for this indication at a dose of 0.5 mg dros-pirenone/1 mg estradiol (marketed in the United States as Angeliq by Berlex Laboratories Inc.). During its development, it was noted that at a higher dros-pirenone dose, the combination also had antihypertensive properties. It is currently being used in Europe, Asia, and the rest of the world at a dose of 2 mg drospire-none/1 mg estradiol, Dr. White told this news organization.

In a multicenter (42 U.S. centers and 22 European centers) trial, Dr. White and his colleagues evaluated the blood pressure-lowering efficacy of various doses of drospirenone (1, 2, or 3 mg) combined with 1 mg of estradiol in 750 postmenopausal women aged 45-75 years, with an untreated systolic blood pressure of 140-179 mmHg and untreated diastolic blood pressure of 90-109 mm Hg.

They also evaluated estradiol alone to elicit data on the effects of estrogen on ambulatory blood pressure, about which little is known.

In addition, because drugs which induce aldosterone blockade have been shown to increase serum potassium, the researchers evaluated the metabolic effects of the combination therapy.

Following a single-blind, placebo phase for 3-4 weeks to establish baseline blood pressure and laboratory values, the women were randomized to one of the three combination treatment arms, to estradiol alone, or to placebo. Twenty-four hour ambulatory blood pressure monitoring was done at baseline and at 8 weeks.