Effect of medroxyprogesterone on pulmonary arterial pressure, exhaled nitric oxide, ECG and arterial blood gases.

Abstract

OBJECTIVES: To evaluate the effect of medroxyprogesterone acetate (MPA) therapy on pulmonary arterial pressure (PAP), exhaled nitric oxide (NO), electrocardiogram (ECG), and on arterial blood gases (ABG). DESIGN: A double-blind randomized placebo-controlled cross-over trial. SETTING: University hospital in Turku, Finland. SUBJECTS: Fourteen postmenopausal women with respiratory impairment. INTERVENTIONS: A 2-week placebo and a 2-week MPA period (60 mg day -1) followed by 6-week placebo or MPA washout periods. MAIN OUTCOME MEASURES: The systolic PAP was estimated by Doppler echocardiography. PAP, ECG, NO and ABG were monitored at baseline, after 2-week placebo and MPA periods, and after 3- and 6-week placebo and MPA washout periods. RESULTS: The mean PaCO2 at baseline was 5.4 +/- 0.6 kPa (mean +/- SD). The average decrease of PaCO2 on MPA was -0.8 +/- 0.3 kPa (P < 0.001) and 0.3 +/- 1.0 kPa (P = 0.007) at the 3-week washout. The mean systolic PAP at baseline was 44.3 +/- 14.5 mm Hg. MPA did not change PAP until the 6-week washout, when the average increase of + 6.9 +/- 19.8 mm Hg (P = 0.002) was observed. No changes occurred in PaO2, exhaled NO or the ECG axes. The PR interval was shorter only on MPA (15.9 +/- 27.0 ms, P = 0.020) whereas the QRS duration remained shorter up to 3-week washout (3.9 +/0 5.5 ms, P = 0.008 and 4.0 +/- 14.3 ms, P = 0.032). The systolic and diastolic BP and the heart rate did not change. CONCLUSIONS: Despite prolonged decrease in PaCO2, short-term MPA had no effect on exhaled NO and did not decrease systolic PAP in postmenopausal women with respiratory impairment. MPA shortened the PR interval and the QRS duration, the latter effect being sustained at least up to 3 weeks.