What is the correlation between menopause and increased risk for hypertension (high blood pressure) in women?

From the Guidelines

Menopause is significantly associated with an increased risk of hypertension in women, primarily due to the decline in estrogen levels, which leads to increased arterial stiffness, endothelial dysfunction, and activation of the renin-angiotensin-aldosterone system, all contributing to elevated blood pressure. According to the most recent study 1, hypertension is a key risk factor for cardiovascular morbidity and mortality in women, and menopause is one of the female-specific risk factors that contribute to the development of hypertension. The study suggests that the development of hypertension starts in young, premenopausal women, often in association with disorders of reproductive organs, and therefore needs to be managed early in life to prevent future cardiovascular disease.

The correlation between menopause and increased risk for hypertension is supported by several studies, including a study published in 2020 1, which found that the prevalence of hypertension among premenopausal women tends to be lower than men of similar age, but hypertension becomes more prevalent in women after menopause. Another study published in 2003 1 also found that postmenopausal women are more than twice as likely to have hypertension as premenopausal women.

The decline in estrogen levels during menopause leads to unfavorable changes in body fat distribution, insulin sensitivity, and sympathetic nervous system activity, further elevating hypertension risk. Regular blood pressure monitoring becomes essential during and after menopause, with lifestyle modifications, such as reducing sodium intake to <2300mg daily, regular exercise of 150 minutes weekly, maintaining healthy weight, limiting alcohol, and managing stress, forming the foundation of prevention. While hormone replacement therapy may help some women with menopausal symptoms, it is not recommended specifically for hypertension management, which typically requires standard antihypertensive medications when lifestyle changes prove insufficient.

Key points to consider in the management of hypertension in women include:

• The importance of early detection and management of hypertension in premenopausal women
• The need for regular blood pressure monitoring during and after menopause
• The role of lifestyle modifications in preventing and managing hypertension
• The potential benefits and risks of hormone replacement therapy in women with menopausal symptoms
• The importance of considering female-specific risk factors, such as menopause, in the development of hypertension guidelines and management strategies.

From the Research

Correlation between Menopause and Hypertension

• Menopause is associated with an increased risk of cardiovascular disease (CVD), including hypertension, due to the decline in estrogen levels 2, 3, 4, 5, 6.
• The decline in estrogen levels during menopause can lead to changes in body fat distribution, reduced glucose tolerance, abnormal plasma lipids, increased blood pressure, and endothelial dysfunction, all of which contribute to the development of hypertension 2.
• Studies have shown that women with early menopause (age at menopause <45 years) are at a higher risk of developing arterial hypertension compared to those with normal age at menopause (>45 years) 5.
• Hormone replacement therapy (HRT) started soon after menopause may confer cardiovascular benefits, including reducing blood pressure in postmenopausal women with elevated blood pressure 2.
• The unique progestogen drospirenone has antialdosterone properties, which can counteract the water- and sodium-retaining effects of estrogen, potentially reducing blood pressure in postmenopausal women 2.

Risk Factors for Hypertension in Menopausal Women

• Age at menopause and time since menopause are factors that increase CVD risk, including hypertension 6.
• Metabolic syndrome (MetS) is a significant risk factor for CVD, including hypertension, in menopausal women 6.
• Other risk factors for hypertension in menopausal women include changes in body fat distribution, reduced glucose tolerance, abnormal plasma lipids, and endothelial dysfunction 2, 3, 4.

Management of Hypertension in Menopausal Women

• Treatment of arterial hypertension and glucose intolerance should be priorities in postmenopausal women 2.
• Improved screening for hypertension, especially in specific groups of younger women at higher risk, is recommended 3.
• Further study is needed to determine whether sex-specific differences exist in therapeutic response to pharmacologic management of hypertension 3.