ObjectiveTo determine the detailed effects of hormone replacement therapy (HRT) on non-invasive haemodynamics, including an assessment of the effect on the pulsatile afterload assessed in terms of the augmentation index and pulse-wave velocity.DesignA cross-sectional study of healthy postmenopausal women using carotid and radial tonometry and pulse-wave velocity measurements.SettingCommunity-based ambulatory women attending the menopause centre at a tertiary hospital.PatientsSeventy postmenopausal women divided into those not currently being administered HRT (n = 38, aged 46–72 years) and those who were being administered a variety of HRT (n = 32, aged 49–67 years).MethodsCentral arterial pressure waveforms were measured using carotid applanation tonometry to derive the augmentation index and ejection duration. The arterial pulse-wave velocity was assessed using paired carotid, radial and dorsalis tonometry waveforms.ResultsWomen being administered HRT had a significantly lower augmentation index (20.4 ± 8.6 versus 27.0 ± 10.2%,P= 0.005) and shorter ejection times (320 ± 17 versus 329 ± 18 ms,P= 0.037). There was no significant difference in brachial blood pressure (131/76 versus 129/77 mmHg). Women being administered HRT exhibited a greater reversal in the age-related loss of amplification which occurs owing to arterial stiffening. This amplification between central and peripheral systolic blood pressures was greater among women being administered HRT (5.3 ± 6.2 versus 2.2 ± 4.0 mmHg,P= 0.014). There was no difference in pulse-wave velocity between the two groups.ConclusionsHRT appears to improve the pulsatile vascular afterload by decreasing the augmentation of the late systolic blood pressure. This effect is not apparent from routine brachial cuff measurements, which, as a result, may underestimate haemodynamic benefits. Such effects may help to explain a portion of the improvement in cardiovascular morbidity found in other trials.