Excess Systolic Hypertension in Post-Menopausal Women Originates in Their Early-30s, a Decade Before the Decline of Estrogen Concentrations Decline

Abstract

Background: In young adults blood pressure, hypertension rates, and CVD risk are lower in women than similarly aged men. However, soon after menopause hypertension and CVD rates converge with, and overtake those of men. Thus, by their mid-50s, most women are hypertensive, and CVD becomes the leading cause of death. While this age-related increase in blood pressure and hypertension is largely attributed to menopause, and the concomitant decrease in estradiol concentrations, there is little empirical evidence to support this hypothesis. Methods: Data from the National Health and Nutrition Examination Survey (NHANES) and Coronary Artery Risk Development in Young Adults (CARDIA) study was analyzed by segmented regression analysis to determine the relationship between systolic blood pressure and age. Data from NHANES was further stratified by Body Mass Index (BMI) and antihypertensive drug use to determine their impact on blood pressure. Estradiol concentrations (NHANES 2013-2016) were graphed against age to determine the start of menopause. Findings: Segmented regression analysis determined that the age-related increase in systolic blood pressure and systolic hypertension began when the women were in their early-30s, a decade before estrogen concentrations decline. BMI and antihypertensive drug use modified the response, but not the overall trend. Interpretation: Contrary to the commonly cited hypothesis, the age-related increase in hypertension is not related to menopause, nor decreased estradiol concentrations. Rather, the rise in systolic blood pressure and hypertension begins over a decade earlier, in a woman’s early-30s. These finding suggest that monitoring, and perhaps prophylactic treatment, of hypertension should begin at least a decade before menopause. Funding Statement: No funding was received for this study, nor for preparing and submitting the manuscript. Declaration of Interests: The Authors states that there is no conflict of interest. Ethics Approval Statement: Ethical approval for the study was provided by the University of Florida Institutional Review Board.