Hypertension Across a Woman’s Life Cycle

Abstract

Hypertension accounts for 1 in 5 deaths among American women, posing a greater burden for women than men, and is among their most important risk factors for death and development of cardiovascular and other diseases. Hypertension affects women in all phases of life, with specific characteristics relating to risk factors and management for primary prevention of hypertension in teenage and young adult women; hypertension in pregnancy; hypertension during use of oral contraceptives and assisted reproductive technologies, lactation, menopause, or hormone replacement; hypertension in elderly women; and issues of race and ethnicity. All are detailed in this review, as is information relative to women in clinical trials of hypertension and medication issues. The overarching message is that effective treatment and control of hypertension improves cardiovascular outcomes. But many knowledge gaps persist, including the contribution of hypertensive disorders of pregnancy to cardiovascular disease risk, the role of hormone replacement, blood pressure targets for elderly women, and so on.

Prevention = Pre-Conception Counselling

“…Women with pre-existing hypertension or cardiac disease, a history of significant obstetrical-induced hypertension, or a history of fetal or neonatal congenital heart disease require important pre-conception counselling related to the maternal and fetal risks in a subsequent pregnancy (Table 1). [1][2][3][4][5][6][7][8] Clapp and Bernstein summarize the pre-conception counselling approach for women with cardiac disease that uses risk stratification and pre-pregnancy optimization (workup, medication exposures, genetics). 1 According to the Public Health Agency of Canada, 9 6% of pregnancies are complicated by hypertension, roughly evenly split between chronic hypertension and gestational hypertension or preeclampsia.…”

“…3 Throughout the female life cycle, there is an increased hypertensive risk that requires effective treatment and control. 2 The risk of persistent (post-pregnancy) hypertension in women with a history of a hypertensive disorder of pregnancy is high, both immediately after an affected pregnancy and persisting, because up to 33% of women may develop hypertension within a decade of an affected pregnancy. 11 Women with a prior history of hypertensive disorder of pregnancy have been found to have a significantly increased "all-cause mortality" with an adjusted HR (aHR) of 1.65 (95% CI 1.57-1.73).…”

“…A comprehensive individualized pre-conception care process emphasizes that pregnancies should be planned and recognizes the need for pregnancy preparation by the woman and her most responsible health provider. 1,2…”

Female‐friendly focus: 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease

“…Although more men than women have hypertension up to age 45, after age 65 the occurrence of hypertension increases sharply in U.S. women with 80% of women aged 75 and older having hypertension. Important for preventive interventions, there is an impressive correlation of increased BMI with increased systolic blood pressure in women Tobacco use …”

Efeitos dos treinos intervalados de longa duração e de curta duração sobre as respostas hemodinâmicas de idosos com hipertensão arterial

“…Pesquisas apontam que a prevalência de hipertensão aumenta acentuadamente com o envelhecimento, ultrapassando 90% das pessoas com idade igual ou superior a 80 anos (WENGER et al, 2018). Tal contexto provoca grandes desafios à saúde pública e a necessidade de adequação dos serviços a essa nova demanda.…”