High blood pressure and menopause: test and act to avoid cardiovascular accidents!

Menopause is associated with a significant increase in arterial and metabolic risk. Arterial hypertension is common in post-menopausal women, with one in two women over the age of 55 having a blood pressure greater than or equal to 140/90 mm Hg.

Repeated measurement of blood pressure should be routine at every consultation. Ambulatory measurements, outside the doctor's office, should be encouraged, as nocturnal blood pressure screening is particularly cost-effective in the prevention of cardiovascular disease in women. Self-measurement of blood pressure with a device worn on the arm (rather than the wrist) should be encouraged in the menopause. Self-measurement is based on the "rule of 3": 3 blood pressure readings in the morning on waking, in a quiet seated position, and three blood pressure readings in the evening before going to bed, in a quiet seated position, on three consecutive days. The average of the 18 measurements must be strictly below 135/85 mm Hg to qualify as normotension. After ambulatory confirmation of hypertension, anti-hypertensive treatment will be initiated, in conjunction with a healthier lifestyle (particularly reduced salt and alcohol consumption), taking into account the overall level of cardiovascular risk. There are no specific therapies to promote in hypertensive women, with the exception of thiazide diuretics in osteoporotic women. In hypertensive women under 60 with incapacitating climacteric symptoms and no history of arterial or venous cardiovascular disease, transdermal hormone therapy alone may be proposed within 10 years of the onset of menopause, subject to prior consultation between the gynecologist, cardiologist and attending physician, and to informed notification of the benefit-risk balance of hormone therapy recorded in the medical record. In France, cooperation between cardiovascular physicians, gynecologists and GPs should be promoted to optimize the care of these at-risk women and improve professional practices. This is one of the three missions of Agir pour le Cœur des femmes, to help set up care paths around women's health, based on its flagship screening and alert campaign, the Bus du Cœur des Femmes.

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