Menopause and Hypertension

Abstract

Premenopausal women (pre-MW) have lower blood pressure (BP) than age-matched men, and women have higher rates of hypertension than men as they age.1 These findings suggest that gender or sex hormones have a prominent role in hypertension. Determining the role of sex hormones in the pathogenesis or progression of hypertension is complex given the effects of aging on the cardiovascular system and its relationship to other powerful risk factors such as body weight and cholesterol level.2 Longitudinal and cross-sectional studies report conflicting results concerning the role of menopause in the pathogenesis of hypertension. Large randomized trials of hormone replacement therapy (HRT) have called into question the long assumed protective effect of estrogen in heart disease risk.3,4 There are excellent reviews on the effects of gender and sex hormones on vascular tone and pathophysiologic abnormalities associated with hypertension in animals.5,6 This review focuses on studies in postmenopausal women (PMW), the relationship between menopause and hypertension, factors contributing to hypertension in PMW, and discussion of identification and treatment of hypertension in PMW. ### Studies Indicating Menopause Leads to Increasing Hypertension Cross-sectional studies suggest a relationship between menopause and both hypertension and serum cholesterol7 (Table⇓). Both systolic and diastolic BP are reported to be related to menopause independent of age, body mass index (BMI), pulse rate, and HRT, and PMW had greater odds of being hypertensive than pre-MW (OR 2.2, P =0.03).8 In addition, the association between BP and age is steeper in PMW. View this table: Table. Studies Describing Relationship Between Menopausal Status and Blood Pressure or Cardiovascular Events View this table: Table. Continued Longitudinal cohort studies also demonstrated a relationship between menopause and hypertension. In a study of 315 women and age- and BMI-matched men followed for 5 years, PMW had higher systolic BP at baseline and systolic BP increased by approximately 5 mm Hg over 5 years …