High blood pressure is one of the most significant risk factors for cardiovascular disease. Dr Deborah Lee of Dr Fox Online Pharmacy explains how women can protect their heart health
According to the World Health Organization (WHO), high blood pressure (also called hypertension) is the leading risk factor for cardiovascular diseases. It caused almost a quarter (24%) of Europe’s CVD deaths in 2019 alone. It may surprise you to know that 60% of women over the age of 65 have high blood pressure. It’s particularly important as high blood pressure can be treated and the risk of CVD reduced, so long as it is picked up early enough.
Why are postmenopausal women more at risk of high blood pressure?
Women are protected from CVD before menopause by their own oestrogen. However, in association with falling oestrogen levels, women start to develop atherosclerotic changes in their arterial walls as early as their 40s. After menopause, calcification and inflammation develop within the vessel walls. Most CVD events – angina, heart attacks, and strokes – occur in women after the age of 63.
Various research studies have confirmed that women who take HRT in their 50s and continue through the next five to ten years have a reduced risk of CVD. But women who do not start HRT until their 60s have an increased risk of CVD events, probably because oestrogen causes vasodilation of the calcified endothelium (the cells lining the blood vessel wall) and can destabilise plaques which have formed on the arterial wall during atherosclerosis. Fragmentation of plaques or rupture of the vessel wall is the cause of micro-emboli (clots) or haemorrhage, which block arteries or damage heart or brain tissue, causing heart attacks and strokes.
How does menopause cause high blood pressure?
Stiffening of the arterial walls: The rise in systolic (upper reading) blood pressure is mostly due to the increasing stiffness of the arterial wall that occurs with ageing. Blood pressure rises more steeply in women than it does in men in the fifth decade, probably largely due to the absence of oestrogen.
Increased activation of the RAS system: The decline in oestrogen leads to an increase in the renin-angiotensin system (RAS) in the kidney. This specialised enzyme system controls blood pressure in the human body. Increased RAS activity leads to higher levels of angiotensin-11 and aldosterone, which results in sodium retention, vasoconstriction, and raised blood pressure.
The effects of HRT on the kidney: Oral HRT increases levels of the protein angiotensinogen, which causes vasoconstriction, which raises blood pressure. However, it also reduces renin levels, which largely counteracts these blood-pressure-elevating effects.
Increased salt sensitivity: Postmenopausal women have increased salt sensitivity, meaning their kidneys have an exaggerated response to salt ingestion.
Being overweight or obese: 66-69% of UK women over the age of 45 are overweight or obese. Obesity results in oxidative stress, insulin resistance and raised levels of systemic inflammation – all of which are associated with hypertension. In addition, obese postmenopausal women have increased sympathetic nervous system activity, which causes high pressure.
Metabolic syndrome: Being postmenopausal increases the risk of metabolic syndrome by 60%. The risk is highest in postmenopausal women with obesity, but metabolic syndrome can be present in those with a BMI in the normal range. Metabolic syndrome is the name given to a dangerous cluster of risk factors that increase CVD risk. These are abdominal obesity, high blood pressure, raised fasting glucose, raised triglyceride levels, and low HDL (’good’) cholesterol levels.
Managing high blood pressure in postmenopausal women
HRT is not a cause of high blood pressure: At present, HRT should not be prescribed solely to lower blood pressure, although it does tend to have a blood pressure-lowering effect. HRT is prescribed to help women with menopausal symptoms, including hot flushes, night sweats, insomnia, fatigue and brain fog. However, it is thought to have an additional CVD benefit. There are non-hormonal options for women who cannot take HRT.
Improve lifestyle factors: Women are strongly advised to do what they can to lower their CVD risk. This means stopping smoking, losing weight, eating healthily, and exercising.
Eat a healthy diet: Diet is extremely important. Women need to have a low-salt diet and not eat processed and ultra-processed foods. Heart-healthy foods are fresh fruit and vegetables along with whole grains, nuts and seeds. Plenty of lean protein such as chicken or fish are vital, as well as healthy unsaturated (plant-based) fats such as olive, sunflower, rapeseed or avocado oil. Cut back on red meat. Avoid high fat, high sugar, high salt foods – cook from scratch at home with good quality ingredients.
Reduce alcohol: Reduce your alcohol consumption or stop drinking altogether. Alcohol is empty calories. Over the long term, alcohol raises blood pressure.
Lower stress: De-stress in any way you can. This could be yoga, meditation or Tai Chi. Exercise such as brisk walking helps lower stress. Hot and cold therapy is helpful. Even reading a book for 30 minutes a day can lower stress. Factor time to destress into your day every day.
Improve your sleep: Much research links insomnia to high blood pressure. Make sure you establish a good night-time routine, winding down for bedtime, and have a cool, dark bedroom and a comfortable mattress. Switch off blue light devices (TVs, computers, iPads and smartphones) two hours before bedtime. No caffeine or alcohol with six hours of going to bed.
Take blood pressure-lowering medication as advised by your GP: High blood pressure can be treated with medication in the usual way. Postmenopausal women often get good blood pressure control with diuretics and ACE (angiotensin-converting enzyme) inhibitors.
Twice as many women die from heart disease as from breast cancer; twenty-six thousand people under the age of 75 die every year in the UK from CVD. High blood pressure is also a major risk factor for CVD and stroke. It is crucial to be aware of stroke symptoms. Research indicates that the occurrence of vertigo, which can be a symptom of stroke, rises with age and is about two to three times more common in women than in men. Acute Vestibular Syndrome (AVS) is a sudden onset of spinning vertigo that occurs without warning and lasts for at least 24 hours. The two primary causes of AVS are inner ear infection and stroke.
Overall, it is important that postmenopausal women have their blood pressure taken and act on the result. Too often, the first time a woman finds out she has high blood pressure is when she has a heart attack or a stroke. Many research studies have confirmed that lowering high blood pressure saves lives by lowering CVD risk.
