Hypertension in menopausal women – a special case ,for special treatment?

Abstract

After the menopause the consequences of hypertension in women change. Their risks of myocardial infarction and stroke rise steeply ,a rise that has been blamed in part on the loss of estrogen and the onsetof menopausal metabolic syndrome ,with endothelial dysfunction ,hyperlipidemia ,insulin resistance and derangement in coagulation. Hypertensive menopausal women have not had optimum treatment. They havepoorer prognoses than men of the same age. Their antihypertensive management therefore merits special attention. Hormone replacement ,aspirin prophylaxis and lipid-lowering drugs have their place. The antihypertensivedrug chosen should not worsen the metabolic syndrome: angiotensin-II converting enzyme (ACE) inhibitors are therefore among the first-line drugs. Few drugs have been specifically aimed at menopausal hypertensionand these are reviewed here.