The acute effects of sublingual estradiol on left ventricular diastolic function in normotensive and hypertensive postmenopausal women

Aim: limited information is available on estrogen influences on diastole. We aimed to investigate the acute effects of a single dose of sublingual 17β-estradiol on left ventricular diastolic function in postmenopausal women. Methods: The study included 28 women aged 55.6±6 (15 normotensive and 13 hypertensive), who underwent Doppler echocardiography and estradiol plasma levels determination before and 60 min after sublingual administration of 4 mg of 17β-estradiol. Results: There were no modifications in heart rate. Both systolic and diastolic blood pressure dropped significantly in the hypertensives and remained unchanged in normotensives. Estradiol levels were 1790±869 pg/ml in the normotensives and 2664±1490 in the hypertensives (P<0.05). Peak early velocity, in the population as a whole, increased from 84±18 to 91±18 cm/s and the early-to- atrial velocity ratio from 1.1±0.4 to 1.4±0.6 (P<0.0001 for both). Both acceleration and deceleration rates increased significantly (P<0.0001). These changes were shared by all the patients. In addition, the hypertensive patients, who presented a baseline pattern characterized mainly by a grossly increased peak atrial velocity with reduction in the early-to-atrial velocity ratio, demonstrated a decrease in peak atrial velocity from 92±12 to 78±10 cm/s (P<0.0001), associated with significant reductions in deceleration time (P<0.0001) and pressure half time (P<0.005). Therefore, the typical picture of impaired ventricular relaxation was favorably changed after estradiol administration. Conclusions: The sublingual administration of estradiol induces acute modifications in left ventricular diastolic function in postmenopausal women, with improvement in the age-related left ventricular relaxation pattern, and that these beneficial changes are more pronounced in hypertensive that in normotensive women.