High Blood Pressure in Women: Pregnancy, Menopause and Old Age

High blood pressure is the deadliest risk factor for women worldwide [1], with the risk of cardiovascular disease increasing at lower blood pressure levels in women compared to men [2].

Blood pressure, can vary significantly in women throughout different stages of life, including pregnancy, menopause, and as we get older. Understanding and being aware of these changes is crucial for maintaining heart health and preventing hypertension-related complications.

What Symptoms Do Women Get with High Blood Pressure?

Many women will get no symptoms or warning signs at all that their blood pressure is raised, hence the importance of regularly checking it. Often only once BP is significantly raised can you experience symptoms, though some women may notice some of these subtle symptoms earlier which include:

• headaches
• dizziness or loss of balance
• getting shorter of breath on activity
• chest pains
• palpitations
• blurred or double vision 
• occasionally nosebleeds can be an indicator. 

Blood Pressure During Pregnancy

• Blood pressure during early pregnancy: Blood pressure typically decreases during the first and second trimesters due to hormonal changes that cause blood vessels to dilate. This helps accommodate increased blood flow to support the developing baby. 
• Blood pressure during late pregnancy: Blood pressure may rise slightly as the pregnancy progresses. However, significant increases can be a sign of pregnancy-related hypertension conditions such as pre-eclampsia, which requires immediate medical attention.

Hypertension during pregnancy can be a risk factor for developing hypertension later in life [3].

High Blood Pressure in Menopause

You’re at your highest risk of developing hypertension after menopause, but sadly a big proportion of people are going undiagnosed due to not checking their BP and often not being aware until secondary events such as heart attacks or strokes occur. 

Menopause marks the end of menstrual cycles and is associated with many changes that can impact blood pressure:

• Hormonal fluctuations: The decline in oestrogen levels during menopause can lead to increased arterial stiffness and reduced elasticity, contributing to higher blood pressure.
• Weight gain: Many women experience weight gain during menopause, which can increase the risk of developing hypertension.
• Insulin resistance: Post-menopausal women may also develop insulin resistance, which is linked to higher blood pressure and an increased risk of cardiovascular diseases.
• Trigger for genetic susceptibilities: it’s possible for menopause to trigger an expression of certain genetic susceptibilities, resulting in genetic influences that mediate hypertension [4].

High Blood Pressure in Old Age

As women age, blood pressure tends to increase, posing a higher risk of hypertension and related health issues, including:

• Arterial stiffness: Aging causes arteries to stiffen and lose elasticity, making it harder for blood to flow smoothly, thus increasing blood pressure.
• Decreased kidney function: The kidneys, which help regulate blood pressure, can become less efficient with age, leading to fluid and sodium retention and higher blood pressure.
• Lifestyle factors: Factors such as reduced physical activity and unhealthy diet are common in older age. 
• Relative lifetime contributions: During a woman’s life, events such as menstrual cycling, pregnancy, menopause, oral contraceptive use, hormone replacement therapy, etc have the potential to alter their CV systems [1].

What Can Women Do to Reduce Their High Blood Pressure? 

Regardless of age, the best thing you can do to reduce your risks are to eat a healthy diet, take regular exercise and monitor your own BP from time to time. You will then reduce your risks but also detect problems much earlier. 

References:

1. Wegner NK, Arnold A, Merz NB et al.  Hypertension Across a Woman’s Life Cycle. J Am Coll Cardiol. 2018 Apr 24; 71(16): 1797–1813.
2. Lloyd-Jones D, Adams R, Carnethon M, et al. Heart disease and stroke statistics--2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2009;119:480–6.
3. Mannisto T, Mendola P, Vaarasmaki M, et al. Elevated blood pressure in pregnancy and subsequent chronic disease risk. Circulation. 2013;127:681–90.
4. Coylewright M, Reckelhoff JF, Ouyang P. Menopause and hypertension: an age-old debate. Hypertension. 2008;51:952–9.