Postmenopausal Hypertension

Abstract

Hypertension in women is often undiagnosed or inadequately treated, especially after menopause when cardiovascular risk increases. In premenopausal women, endogenous estrogens maintain vasodilation and thus contribute to blood pressure control. Aging and the loss of endogenous estrogen production after menopause are accompanied by increases in blood pressure, contributing to the high prevalence of hypertension in older women. Currently, ≈75% of postmenopausal women in the United States are hypertensive. The high prevalence of obesity, the lack of regular physical exercise, and dietary salt are important factors contributing to and aggravating postmenopausal hypertension. In view of the ongoing population aging throughout the world, diagnosis and treatment of hypertension in postmenopausal women are important to reduce the excess burden of associated cardiovascular disease and to improve outcomes of potentially fatal complications such as stroke and myocardial infarction. This article discusses current knowledge about the mechanisms and therapeutic issues related to postmenopausal hypertension. More than 25% of the female adult world population is hypertensive.1 Elevations in blood pressure in women are related to cardiovascular risk (Figure, panel A),2,3 with the prevalence of hypertension being particularly high among women aged ≥60 years.1 In the United States, ≈75% of postmenopausal women are hypertensive.4 Hypertension is often accompanied by other cardiovascular risk factors, eg, obesity, dyslipidemia, and diabetes mellitus.5 It is noteworthy that the prevalence of hypertension-related cardiovascular complications is greater in postmenopausal women than in age-matched men.6 Indeed, these complications represent the leading cause of death in women.6 Figure. A, Cumulative incidence of cardiovascular events in women without hypertension, according to blood pressure category at the baseline examination. Vertical bars indicate 95% CIs. According to earlier classifications from the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, optimal blood …