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In Reply Zhou et al raise concern about the possibility that use of venlafaxine may contribute to the increased risk of cardiovascular disease (CVD) after menopause because of its effects on blood pressure. In our 3-arm trial (n = 339), we reported that both low-dose oral 17β-estradiol, 0.5-mg/d, and venlafaxine, 75-mg/d, were more effective than placebo for treating women with vasomotor symptoms (VMS) associated with menopause.1 We addressed the safety profile associated with each intervention. Both medications were well tolerated, with only 11 participants (3.2%) discontinuing treatment because of adverse events (estrogen therapy [ET], n = 4; venlafaxine, n = 5; and placebo, n = 2). We reported small mean changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP): SBP and DBP declined by 6.0 and 0.9 mm Hg, respectively, with ET; declined by 5.6 and 1.4 mm Hg, respectively, with placebo; and increased by 0.5 and 2.1 mm Hg, respectively, with venlafaxine. Of the 12 women who developed SBP higher than 165 mm Hg or DBP higher than 95 mm Hg, 10 were assigned to venlafaxine, representing 10.4% of those assigned to the venlafaxine treatment arm. In our trial, women who appeared to be at greater risk for developing high blood pressure were more likely to be overweight or obese and have higher baseline SBP and DBP.
Joffe H, LaCroix AZ, Cohen L. Concern About the Use of Venlafaxine to Treat Vasomotor Symptoms—Reply. JAMA Intern Med. 2015;175(4):658-659. doi:10.1001/jamainternmed.2014.7997