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Oral Contraceptive Can Boost Enalapril's Antihypertensive Effects In Postmenopausal Women

Drospirenone/17b-estradiol can significantly boost enalapril's blood pressure-lowering effect in postmenopausal women with hypertension.

Aldosterone has been implicated in the pathogenesis of progressive cardiovascular disease. Drospirenone is a novel progestin with aldosterone receptor antagonist activity.

Richard A. Preston, at the University of Miami School of Medicine, in Miami, Florida, United States, and colleagues compared the additive effect of drospirenone/17b-estradiol versus placebo on 24-hour ambulatory blood pressure in postmenopausal women with hypertension treated with enalapril maleate.

In this double-blind, two-parallel group trial, 24 postmenopausal women, who were receiving 10 mg of enalapril twice a day prior to the study, were randomized to receive drospirenone/17b-estradiol plus enalapril or placebo plus enalapril for 14 days.

Twenty-four-hour ambulatory blood pressure, plasma renin activity, and serum aldosterone were determined at baseline and on day 14.

The 24-hour mean blood pressure in patients receiving drospirenone/17b-estradiol plus enalapril decreased significantly more from baseline compared with patients receiving placebo plus enalapril. The mean systolic decline was 9 mm Hg, while the mean diastolic pressure decreased 5 mm Hg, the researchers reported.

Essentially, no blood pressure change from baseline was observed among the patients receiving placebo plus enalapril.

Mean aldosterone levels increased 2.6 ng/dL from baseline in the drospirenone/17b-estradiol plus enalapril group, while it decreased 0.3 ng/dL in the placebo plus enalapril group. This is consistent with an antimineralocorticoid effect, the researchers said.

"Our results suggest a significant additive blood pressure-lowering effect of drospirenone/17b-estradiol on both systolic and diastolic blood pressure in hypertensive postmenopausal women receiving enalapril, consistent with an antimineralocorticoid effect," the investigators concluded. "Drospirenone/17b-estradiol, a hormone replacement therapy with antimineralocorticoid effects, could offer a novel potential mechanism for reducing cardiovascular end points in postmenopausal women."
Am J Hypertens 2002; 15: 816-822. "Additive effect of drospirenone/17-BETA-estradiol in hypertensive postmenopausal women receiving enalapril"

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