Published Online
on April 17, 2006

A more recent version of this article appeared on June 1, 2006

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Submitted on October 27, 2005
Revised on November 15, 2005

Surgical Menopause Increases Salt Sensitivity of Blood Pressure

Ivonne Hernandez Schulman; Pedro Aranda; Leopoldo Raij^*; Maddalena Veronesi; Francisco J. Aranda; and Remedios Martin

From the Nephrology and Hypertension Section (I.H.S., L.R.), Veterans Affairs Medical Center, Division of Nephrology and Hypertension and Vascular Biology Institute, University of Miami Miller School of Medicine, FL; Hypertension and Vascular Risk Unit (P.A., F.J.A., R.M.), University General Hospital, Malaga, Spain; and Department of Internal Medicine (M.V.), University of Bologna, Bologna, Italy.

^* To whom correspondence should be addressed. E-mail: LRaij{at}med.miami.edu.

Abstract--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.

Key words: risk factors • hormones • gender • cardiovascular diseases

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