How to Address High Blood Pressure in Menopause with Effective Gynecardiology Cooperation

During menopause, blood pressure frequently increases. In a study of more than 5,000 women, hot flashes were associated with higher levels of cholesterol, a higher body mass index (relationship of weight and height2) and blood pressure (Gast GC et al. Hypertension 2008). Findings from the 2018 Esteban study in France (www.santepubliquefrance.fr) are very alarming and demonstrate that hypertension isn’t as well controlled in women. Half of women aged 45 to 65 has hypertension, with a significant number of women who do not take any medications. At menopause, progressive estrogen deficiencies lead to thickening of the artery walls and tightening of muscle fibers, which leads to more rigid arteries. This promotes high blood pressure, with increased systolic pressure (the first number in blood pressure readings). In addition, during menopause, many women progressively adopt a lifestyle that’s not as health, with increased sedentary time, more stress, unbalanced eating, excess salt, tobacco and alcohol use, etc. This promotes weight gain, abdominal obesity, higher triglyceride and bad (LDL) cholesterol levels, as well as higher blood sugar and blood pressure. All of this is a cluster of conditions called metabolic syndrome. This poor lifestyle interferes with the efficacy of blood pressure medications. Finally, psychosocial factors that are much more harmful to women cause or aggravate high blood pressure. Doctors must screen for and take into account depression, chronic stress, social isolation and precarious situations among women when they enter menopause. It’s also important to remember that preeclampsia (hypertension during pregnancy that affects the kidneys) and gestational diabetes are two early risk factors unique to women. They promote development of hypertension and metabolic syndrome during menopause. This means hypertension has a much higher impact on the risk of cardiovascular mortality for women compared to men. Hypertension in women aged 60 and older is not as well controlled as in men of the same age. Their hypertension often becomes more complicated with other diseases/conditions like stroke, hypertrophic cardiomyopathy (heart is too thick), diastolic dysfunction (heart has trouble filling with blood), atrial fibrillation (rhythm disrupted in the atria, which are the upper heart cavities), heart failure (heart can’t correctly pump blood), and kidney disease. It’s important to pay attention to several non-specific warning symptoms that may be similar to those caused by menopause: headaches, palpitations, extreme fatigue, chest pain, loss of energy, shortness of breath, trouble sleeping and concentrating, etc. These symptoms may over time and become more severe in physically or mentally stressful situations. They should lead to screening for high blood pressure. At menopause, it’s important to have your doctor or pharmacist check your blood pressure or check it yourself at home using an automated blood pressure monitor on either arm. The goal is to have blood pressure below 140/90 mm Hg when measure at the clinic or by your pharmacist and under 135/85 mm Hg when measured at home. Cardiologists, vascular specialists, general practitioners, gynecologists and pharmacists should work together to optimize care pathways for women with cardiovascular risk factors. Doctors should also get women involved in their care by helping them prepare their health history (including in gynecology and obstetrics) before consultations, listing the various treatments they’re undergoing and teaching them to measure their own blood pressure. The good news is that no one is doomed to suffer from hypertension. You can take effective action by getting regular screening, adopting a healthy lifestyle (regular physical activity, moderate salt and alcohol consumption and stress management) and carefully following your doctor’s instructions. They’ll also be aware of how certain medications like anti-inflammatory drugs, antidepressants and corticosteroids affect blood pressure. To learn more, download the HTA, Hormones et femmes consensus document in French from www.sfhta.eu.