Postmenopausal Hypertension

Abstract

H ypertension 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, Ϸ75% 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. Hypertension: Important Determinant of Cardiovascular Risk in WomenMore 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 Ն60 years. 1 In the United States, Ϸ75% 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 Clinical studies have documented beneficial effects of antihypertensive therapy on cardiovascular outcome, 5 even in patients Ն80 years of age. 7 Overall recognition, control, and treatment of hypertension in postmenopausal women are still poor in primary care, and hypertension is often not being treated aggressively enough. 4,8 -10 Thus, further improvements of medical and public health measures, awareness of patients and physicians, and improved information policies are needed. Blood Pressure and Endogenous Estrogens: Role of MenopausePrior to menopause, blood pressure is lower in women compared with age-matched men. 11,12 During the menstrual cycle, blood pressure levels are inversely related to circulating estrogen concentrations and lower when 17␤-estradiol levels peak, 12 reflecting the vasodilator activity of endogenous 17␤-estradiol. 13 Similarly, increases of endogenous estrogen production during pregnancy contribute to maintenance of normotension despite marked increases in plasma volume and cardiac output. 12,14 The first decade after menopause is accompanied by an increase in blood pressure ( Figure, panel B). 11,15 In the seventh decade of life, the prevalence of hypertension...

Predominant Role of Nuclear Versus Membrane Estrogen Receptor α in Arterial Protection: Implications for Estrogen Receptor α Modulation in Cardiovascular Prevention/Safety

“…Indeed, the first decade after menopause is accompanied by an increase in blood pressure and has been associated with a higher risk of cardiovascular diseases, such as myocardial infarction and stroke 1. In line with these epidemiological data, clinical and preclinical studies show considerable evidence that estrogen modulates cardiovascular physiological features and function 2.…”

A comparative study of morbidity pattern among rural and urban postmenopausal women of Allahabad, Uttar Pradesh, India

“…12 Ageing and the loss of endogenous estrogen production after menopause are accompanied by increase in blood pressure. 13 Eyes are also affected by fluctuating estrogen and progesterone levels.…”

Hipertensión arterial en la mujer adulta

“…Hasta el momento no se ha descrito una relación entre este tipo de HTA y el antecedente de SHE. Tampoco se conoce relación entre el uso prolongado de ACO y desarrollo de HTAPM 55 . Estudios epidemiológicos han demostrado que en la menopausia aumenta la prevalencia de otros factores de riesgo hipertensivo, como sedentarismo, obesidad y SM, que asociados a la perdida de los estrógenos y al envejecimiento vascular, elevarían la PA 55 .…”

“…No puede atribuirse un rol causal de la HTA-PM a la terapia de reemplazo hormonal (TRH), ya que la probabilidad de aumentar la PA con la TRH en las hipertensas es muy baja 55 . Más aún, aquellas mujeres que reciben TRH presentan mayor descenso nocturno de la PA que las no tratadas 24 .…”