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Hypertension in Premenopausal and Postmenopausal Women

  • Pediatric Hypertension (B Falkner, Section Editor)
  • Published:
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Abstract

Purpose of Review

To examine available clinical data on the differences between premenopausal and postmenopausal women with hypertension (HTN). Clinical conditions related to HTN and reproductive status differ in younger women compared with older women. Due to recent changes in the definition of HTN, the prevalence of HTN has increased significantly in all women. Rising rates of obesity among women of all ages increase the risk for HTN.

Recent Findings

Among younger women, long-term vascular consequences of preeclampsia, the under-reported prevalence of fibromuscular dysplasia, and widespread use of oral contraceptive pills in women with contraindications confer unique risks for HTN-related cardiovascular risk. For older women, insights on vascular aging and hormonal changes with menopause are shown to be gender-specific causal factors for HTN.

Summary

Assessment of risk factors unique to premenopausal and postmenopausal women can facilitate the management of HTN and improve long-term outcomes. Further studies in women are needed to accurately stratify women risk based on these risk factors.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. •• Whelton R, Carey P, et al. ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for prevention, detection, evaluation, and management of high blood pressure in adults. J Am Coll Cardiol. 2017;17:e127–248 2018 Recent guidelines on HTN management.

    Google Scholar 

  2. Falkner, Gidding. SPRINT commentary, Is the SPRINT blood pressure treatment target of 120/80mmhg relevant for children? Hypertension. 2016;67:826–8.

    Article  CAS  PubMed  Google Scholar 

  3. Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, et al. Heart disease and stroke statistics- 2017 update: a report from the American Heart Association. Circulation. 2017;135(10):e146–603. https://doi.org/10.1161/CIR.0000000000000485.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Lloyd-Jones DM, Evans JC, Levy D. Hypertension in adults across the age spectrum: current outcomes and control in the community. JAMA. 2005;294:466–72.

    Article  CAS  PubMed  Google Scholar 

  5. Whelton RC. et al, 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. J Am Coll Cardiol. 2018;71(19):e127–248 table 7.

  6. National Center for Health Statistics. Health, United States, 2016: With Chartbook on Long-term Trends in Health. Hyattsville, MD. 2017. Top 10 leading causes of death in 2015, page 18, Figure 8. Library of Congress, Catalog Number 76-641496, DHHS Publication No 2017-1232.

  7. National Center for Health Statistics. Health, United States, 2016: With Chartbook on Long-term Trends in Health. Hyattsville, MD. 2017, Leading causes of death and numbers of deaths by sex, race, and Hispanic origin, United States, 1980 and 2015, trend tables, page 128. Library of Congress, Catalog Number 76-641496, DHHS Publication No 2017-1232.

  8. • Centers for Disease Control and Prevention, Normal weight, overweight, and obesity among adults aged 20 and over, by selected characteristics: United States, selected years 1988–1994 through 2013–2016. National Center for Health Statistics, Health United States 2017: With Special Feature on Mortality, Hyatsville, Maryland. 2018, table 58, https://www.cdc.gov/nchs/hus/contents2017.htm#058, accessed March 2019. Eye-opening up to date statistics on the obesity crisis in the USA.

  9. Mehta P, Wei J, Wenger N. Ischemic heart disease in women: a focus on risk factors. Trends Cardiovasc Med. 2015;25:140–51.

    Article  PubMed  Google Scholar 

  10. Leggio M, Lombardi M, Caldarone E, Severi P, D’Emidio S, Armeni M. The relationship between obesity and hypertension; an updated comprehensive overview on vicious twins. Hypertens Res. 2017;40:947–63.

    Article  PubMed  Google Scholar 

  11. Xu H, Li PH, Barrow TM, Colicino E, Li C, Song R, et al. Obesity as an effect modifier of association between menstrual abnormalities and hypertension in young adult women: results from project ELEFANT. PLoS One. 2018;13(11):e0207929. https://doi.org/10.1371/journal.pone.0207929

    Article  PubMed  PubMed Central  Google Scholar 

  12. Samson R, Qi A, Jaiswal A, Le Jemtel TH, Oparil S. Obesity-associated hypertension: the upcoming Phenoptype in African-American women. Curr Hypertens Rep. 2017, May;19(5):41. https://doi.org/10.1007/s11906-017-0738-x.

    Article  PubMed  Google Scholar 

  13. Bertone-Johnson ER, Whitcomb BW, Rich-Edwards JW, Hankinson SE, Manson JE. Premenstrual syndrome and subsequent risk of hypertension in a prospective study. Am J Epidemiol. 2015;182(12):1000–9. https://doi.org/10.1093/aje/kwv159.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Lauring JR, Lehman EB, Deimling TA, Legro RS, Chuang CH. Combined hormonal contraception use in reproductive-age women with contraindications to estrogen use. Am J Obstet Gynecol. 2016;215(330):e1–7. https://doi.org/10.1016/j.ajog.2016.03.047.

    Article  CAS  Google Scholar 

  15. Liu H, Yao J, Wang W, Zhang D. Association between duration of oral contraceptive use and risk of hypertension: a meta-analysis. J Clin Hypertens. 2017;19(10):1032–41. https://doi.org/10.1111/jch.13042.

    Article  CAS  Google Scholar 

  16. Davis GC, Gibson KJ, Casley D, Brown MA. Angiotensin II/angiotensinogen (1-7) ratio and 24-h blood pressure throughout the menstrual cycle and in women using oral contraceptives. J Hypertens. 2017;35(6):1178–86. https://doi.org/10.1097/HJH.0000000000001310.

    Article  CAS  PubMed  Google Scholar 

  17. Giribela CR, Consolim-Colombo FM, Nisenbaum MG, Moraes TL, Giribela AH, Baracat EC, et al. Effects of combined oral contraceptive containing 20 mcg of ethinylestradiol and 3mg of drospirenone on the blood pressure, renin-angiotensin-aldosterone system, insulin resistance and androgenic profile of healthy young women. Gynecol Endocrinol. 2015;31(11):912–5. https://doi.org/10.3109/09513590.2015.1062860.

    Article  CAS  PubMed  Google Scholar 

  18. Orio F, Muscogiuri G, Nese C, Palomba S, Savastano S, Tafuri D, et al. Obesity, type 2 diabetes mellitus and cardiovascular disease risk: an uptodate in the management of polycystic ovary syndrome. Eur J Obstet Gynecol Reprod Biol. 2016;207:214–9. https://doi.org/10.1016/j.ejogrb.2016.08.026.

    Article  PubMed  Google Scholar 

  19. Joham AE, Boyle JA, Zoungas S, Teede HJ. Hypertension in reproductive-aged women with polycystic ovary syndrome and association with obesity. 2014. Am J Hypertens. 2015 Jul;28(7):847–51. https://doi.org/10.1093/ajh/hpu251.

    Article  PubMed  Google Scholar 

  20. Luque-Ramirez M, Nattero-Chavez L, Ortiz Flores AE, Escobar-Morreale HF. Combined oral contraceptives and/or antiandrogens versus insulin sensitizers for polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update. 2017;24(2):225–41, 2018. https://doi.org/10.1093/humupd/dmx039.

    Article  CAS  Google Scholar 

  21. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynaecologists’ Task Force on hypertension in pregnancy. Obstet Gynecol. 2013;122(5):1122–31. https://doi.org/10.1097/01.AOG.0000437382.03963.88.

    Article  Google Scholar 

  22. • Gonzalez-Suarez M, Kattah A, Grande J, Garovic V. Renal disorders in pregnancy: core curriculum 2019. Am J Kidney Dis. 73(1):119–30. https://doi.org/10.1053/j.ajkd.2018.06.006 Elegant review on pregnancy in kidney disease.

    Article  PubMed  Google Scholar 

  23. •• Magee LA, von Dadelszen P, Rey E, Ross S, Asztalos E, Murphy KE. Less-tight versus tight control of hypertension in pregnancy. N Engl J Med. 2015;372(5):407–17. https://doi.org/10.1056/NEJMoa1404595 First randomized control trial on HTN goals in pregnancy.

    Article  CAS  PubMed  Google Scholar 

  24. Magee LA, CHIPS Study Group, von Dadelszen P, Singer J, Lee T, Rey E, et al. Do labetalol and methyldopa have different effects on pregnancy outcome? Analysis of data from the Control of Hypertension In Pregnancy Study (CHIPS ) trial. BJOG. 2016;123(7):1143–51. https://doi.org/10.1111/1471-0528.13569.

    Article  CAS  PubMed  Google Scholar 

  25. Behrens I, Basit S, Melbye M, Lykke JA, Wohlfahrt J, Bundgaard H, et al. Risk of post-pregnancy hypertension in women with a history of hypertensive disorders of pregnancy: nationwide cohort study. BMJ. 2017;358:j3078. https://doi.org/10.1136/bmj.j3078.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Gornik HL, Persu A, Adlam D, Aparicio LS, Azizi M, Boulanger M. First international consensus on the diagnosis and management of fibromuscular dysplasia. J Hypertens. 2019;37(2):229–52. https://doi.org/10.1097/HJH.0000000000002019 Excellent new guidelines on diagnosis and management of FMD.

    Article  CAS  PubMed  Google Scholar 

  27. Krittanawong C, Kumar A, Johnson KW, Kaplin S, Virk HUH, Wang Z, et al. Prevalence, presentation and associated conditions of patients with fibromuscular dysplasia. Am J Cardiol. 2019;123(7):1169–72. https://doi.org/10.1016/j.amjcard.2018.12.045.

    Article  PubMed  Google Scholar 

  28. Persu A, Van der Niepen P, Touze E, Gevaert S, Berra E, Mace P. Revisiting fibromuscular dysplasia, rationale of the European Fibromuscular Dysplasia Initiative. Hypertension. 2016;68(4):832–9. https://doi.org/10.1161/HYPERTENSIONAHA.116.07543.

    Article  CAS  PubMed  Google Scholar 

  29. Ferreira I, Hovind P, Schalkwijk CG, Parving HH, Stehouwer CDA, Rossing P. Biomarkers of inflammation and endothelial dysfunction as predictors of pulse pressure and incident hypertension in type 1 diabetes: a 20 year life-course study in an inception cohort. Diabetologia. 2018;61(1):231–41. https://doi.org/10.1007/s00125-017-4470-5.

    Article  CAS  PubMed  Google Scholar 

  30. Zhang HN, Xu QQ, Thakur A, Alfred MO, Chakraborty M, Ghosh A, et al. Endothelial dysfunction in diabetes and hypertension: role of microRNAs and long non-coding RNAs. Life Sci. 2018;213:258–68. https://doi.org/10.1016/j.lfs.2018.10.028.

    Article  CAS  PubMed  Google Scholar 

  31. Honour JW. Biochemistry of the menopause. Ann Clin Biochem. 2018;55(1):18–33. https://doi.org/10.1177/0004563217739930.

    Article  CAS  PubMed  Google Scholar 

  32. Dubey RK, Oparil S, Imthurn B, Jackson EK. Sex hormones and hypertension. Cardiovasc Res. 2002;53(3):688–708.

    Article  CAS  PubMed  Google Scholar 

  33. •• Sylvester MA, Brooks HL. Sex specific mechanisms in inflammation and hypertension. Curr Hypertens Rep. 2019;21(7):53. https://doi.org/10.1007/s11906-019-0959-2 Exciting updates in immune-mediated HTN.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Lee HY, Despres JP, Koh KK. Perivascular adipose tissue in the pathogenesis of cardiovascular disease. Atherosclerosis. 2013;230(2):177–84. https://doi.org/10.1016/j.atherosclerosis.2013.07.037.

    Article  CAS  PubMed  Google Scholar 

  35. Moretti C, Lanzolla G, Moretti M, Gnessi L, Carmina E. Androgens and hypertension in men and women: a unifying view. Curr Hypertens Rep. 2017;19(5):44. https://doi.org/10.1007/s11906-017-0740-3.

    Article  CAS  PubMed  Google Scholar 

  36. Oh GC, Kang KS, Park CS, Sung HK, Ha KH, Kim HC, et al. Metabolic syndrome, not menopause, is a risk factor for hypertension in peri-menopausal women. Clinl Hypertens. 2018;24:14. https://doi.org/10.1186/s40885-018-0099-z.

    Article  Google Scholar 

  37. Millet ERC, Peters SAE, Woodward M. Sex differences in risk factors for myocardial infarction: cohort study of UK Biobank participants. BMJ. 2018;363:k4247. https://doi.org/10.1136/bmj.k4247.

    Article  Google Scholar 

  38. • Miller E. Preeclampsia and cerebrovascular disease, the maternal brain at risk. Hypertension. 2019;74:5–13. https://doi.org/10.1161/HYPERTENSIONAHA New insights into the future risk of stroke after preeclampsia.

    Article  CAS  PubMed  Google Scholar 

  39. Coutinho T, Yam Y, Chow BJW, Dwivedi G, Inacio J. Sex differences in Associations of Arterial Compliance with Coronary Artery Plaque and Calcification Burden. J Am Heart Assoc. 2017;6(8). https://doi.org/10.1161/JAHA.117.006079.

  40. • Safar ME, Smulyan H. Hypertensive cardiovascular risk: pulsatile hemodynamics, gender, and therapeutic implications. Am J Hypertens. 2017;30(10):947–53. https://doi.org/10.1093/ajh/hpx049 New insights into the effects of gender in arterial compliance.

    Article  CAS  PubMed  Google Scholar 

  41. Zhao D, Guallar E, Ouyang P, Subramanya V, Vaidya D, Ndumele CE, et al. Endogenous sex hormones and incident cardiovascular disease in post-menopausal women. J Am Coll Cardiol. 2018;71(22):2555–66. https://doi.org/10.1016/j.jacc.2018.01.083.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Foy C, Lovato L, Vitolins M, Bates JT, Campbell R, Cushman WC, et al. Gender, blood pressure and cardiovascular and renal outcomes in adults with hypertension from the Systolic Blood Pressure Intervention Trial. J Hypertens. 2018;36(4):904–15. https://doi.org/10.1097/HJH.0000000000001619.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Thomas HN, Evans GW, Berlowitz DR, Chertow GM, Conroy MB, Foy CG, et al. Antihypertensive medications and sexual function in women: baseline data from the SBP intervention trial (SPRINT). J Hypertens. 2016;34(6):1224–31. https://doi.org/10.1097/HJH.0000000000000911.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Turnbull F, Woodward M, Neal B, Barzi F, Ninomiya T, Chalmers J, et al. Do men and women respond differently to blood pressure-lowering treatment? Results of prospectively designed overviews of randomized trials. Eur Heart J. 2008;29(21):2669–80. https://doi.org/10.1093/eurheartj/ehn427.

    Article  PubMed  Google Scholar 

  45. •• SPRINT Research Group, Wright JT Jr, Williamson JD, Whelton PK, Snyder JK, Sink KM, et al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015;26(373(22)):2103–16. https://doi.org/10.1056/NEJMoa1511939 First randomized trial to positive outcomes with BP less than 120/80.

    Article  CAS  Google Scholar 

  46. Butt DA, Harvey PJ. Benefits and risks of antihypertensive medications in the elderly. J Intern Med. 2015;278(6):599–626. https://doi.org/10.1111/joim.12446.

    Article  CAS  PubMed  Google Scholar 

  47. Bromfield SG, Ngameni CA, Colantonio ID, Bowlong CB, Shimbo D, Reynolds K, et al. Blood pressure, antihypertensive polypharmacy, frailty and risk for serious fall injuries among older treated adults with hypertension. Hypertension. 2017;70(2):259–66. https://doi.org/10.1161/HYPERTENSIONAHA.116.09390.

    Article  CAS  PubMed  Google Scholar 

  48. Margolis K, Buchnwe D, La Monte, et al. Hypertension treatment and control and risk of falls in older women. J Am Geriatr Soc. 2019;67(4):726–33. https://doi.org/10.1111/jgs.15732.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Prospective studies collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360(9349):1903–13.

    Article  PubMed  Google Scholar 

  50. Zanchetti A, Julius S, Kjeldsen S, McInnes GT, Hua T, Weber M, et al. Outcomes in subgroups of hypertensive patients treated with regimens based on valsartan and amlodipine: an analysis of findings from the VALUE trial. J Hypertens. 2006;24(11):2163–8.

    Article  CAS  PubMed  Google Scholar 

  51. Oparil S, Davis BR, Cushman WC, Ford CE, Furberg CD, Habib GB, et al. Mortality and morbidity during and after Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial: results by sex. Hypertension. 2013;61(5):977–86. https://doi.org/10.1161/HYPERTENSIONAHA.111.00213.

    Article  CAS  PubMed  Google Scholar 

  52. Staessen JA, Fagard R, Thijis L, Celis H, Arabidze GG, Birkenhager WH, et al. Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. The Systolic Hypertension in Europe (Syst-Eur) Trial Investigators. Lancet. 1997;350(9080):757–64.

    Article  CAS  PubMed  Google Scholar 

  53. Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G, et al. Effects of an angiotensin-converting-enzyme inhibitor, Ramipril, on cardiovascular events in high-risk patients. N Engl J Med. 2000;342(3):145–53.

    Article  CAS  PubMed  Google Scholar 

  54. Brenner BM, Cooper ME, de Zeeuw D, Keane WF, Mitch WE, Parving HH, et al. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med. 2001;345(12):861–9.

    Article  CAS  PubMed  Google Scholar 

  55. Wright JT, Bakris G, Greene T, Agodoa LY, Appel LJ, Charleston J, et al. Effect of blood pressure lowering and antihypertensive drug class on progression of hypertensive kidney disease: results from the AASK trial. JAMA. 2002;288(19):2421–31.

    Article  CAS  PubMed  Google Scholar 

  56. Jamerson K, Weber MA, Bakris GL, Dahlof B, Pitt D, Shi V, et al. Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients. N Engl J Med. 2008;359(23):2417–28. https://doi.org/10.1056/NEJMoa0806182.

    Article  CAS  PubMed  Google Scholar 

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Brahmbhatt, Y., Gupta, M. & Hamrahian, S. Hypertension in Premenopausal and Postmenopausal Women. Curr Hypertens Rep 21, 74 (2019). https://doi.org/10.1007/s11906-019-0979-y

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