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Women’s health in menopause with a focus on hypertension


In menopause transition many women have vasomotor symptoms which may affect their normal daily activities. With the decline in oestrogen levels, risk factors for coronary heart disease (CHD) become more apparent, especially hypertension. The onset of hypertension can cause a variety of complaints that are often attributed to the menopause. Risk factor identification is poorly managed in middle-aged women and should be the first step in the evaluation and treatment of women with perimenopausal symptoms. In women at low risk for CHD, there is still a window of opportunity for safe hormone prescription in the first years proximal to menopause. (Neth Heart J 2009;17:68-72.)

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  1. 1

    Hulley S, Grady D, Bush T, Furberg C, Herrington DM, Riggs B, et al. The Heart and Estrogen/progestin Replacement Study (HERS) research group. Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. JAMA 1998; 280:605-13.

  2. 2

    Herrington DM, Reboussin DM, Brosnihan KB, Sharp PC, Shumaker SA, Snyder TE, et al. Effects of estrogen replacement on the progression of coronary-artery atherosclerosis. N Engl J Med 2000;343:522-9.

    Google Scholar 

  3. 3

    Writing group for the Women’s Health Initiative investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women. Principal results of the Women’s Health Initiative controlled trial. JAMA 2002;288:321-33.

    Google Scholar 

  4. 4

    The Women’s Health Initiative Steering Committee. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy. The Women’s Health Initiative randomized controlled trial. JAMA 2004;291:1701-12.

    Google Scholar 

  5. 5

    Collins P, Rosano G, Casey C, Daly C, Gambacciani M, Hadji P, et al. Management of cardiovascular risk in the peri-menopausal woman: a consensus statement of European cardiologists and gynaecologists. Eur Heart J 2007;28:2028-40.

    Google Scholar 

  6. 6

    Gordon T, Kannel WB, Hjortland MC, McNamara PM. Menopause and coronary heart disease. The Framingham Study. Ann Intern Med 1978;89:157-61.

    Google Scholar 

  7. 7

    Bairey Merz CM, Johnson BD, Sharaf BL, Bittner V, Berga SL, Braunstein GD, et al. Hypoestrogenemia of hypothalamic origin and coronary artery disease in premenopausal women: a report from the NHLBI-sponsored WISE study. J Am Coll Cardiol 2003;41:413-9.

    Google Scholar 

  8. 8

    Sutton-Tyrell K, Lassila HC, Meilahn E, Bunker C, Metthews KA, Kuller LH. Carotid atherosclerosis in premenopausal and postmenopausal women and its association with risk factors measured after menopause. Stroke 1998;29:1116-21.

    Google Scholar 

  9. 9

    Christian RC, Harrington S, Edwards WD, Oberg AL, Fitzpatrick LA. Estrogen status correlates with the calcium content of coronary atherosclerotic plaques in women. J Clin Endocrinol Metab 2002;87:1062-7.

    Google Scholar 

  10. 10

    Post WS, Goldschmidt-Clermont PJ, Wilhide CC, Heldman AW, Sussman MS, Ouyang P, et al. Methylation of the estrogen receptor gene is associated with aging and atherosclerosis in the cardiovascular system. Cardiovasc Res 1999;43:985-91.

    Google Scholar 

  11. 11

    Clarkson TB. Estrogen effects on arteries vary with stage of reproductive life and extent of subclinical atherosclerosis progression. Menopause 2007;14:373-84.

    Google Scholar 

  12. 12

    Ouyang P, Michos ED, Karas RH. Hormone replacement therapy and the cardiovascular system. J Am Coll Cardiol 2006;47:1741-53.

    Google Scholar 

  13. 13

    Vickers MR, MacLennan AH, Lawton B, Ford D, Martin J, Meredith SK, et al. Main morbidities recorded in the women’s international study of long duration oestrogen after menopause (WISDOM): a randomized controlled trial of hormone replacement therapy in postmenopausal women. BMJ 2007;335:239-50.

    Google Scholar 

  14. 14

    Pasternak RC, Abrams J, Greenland P, Smaha LA, Wilson PWF, Houston-Miller N. Task force #1- Identification of coronary heart disease risk: is there a detection gap? J Am Coll Cardiol 2003;41:1863-74.

    Google Scholar 

  15. 15

    Mikkola TS, Clarkson TB, Notelovitz M. Postmenopausal hormone therapy before and after the women’s health initiative study: what consequences? Ann Med 2004;36:402-13.

    Google Scholar 

  16. 16

    Rossouw JE, Prentice RL, Manson JE, Wu LL, Barad D, Barnabei VM, et al. Postmenopausal hormone therapy and risk of cardiovascular disease by age and years since menopause. JAMA 2007;297:1465-77.

    Google Scholar 

  17. 17

    Manson JE, Allison MA, Rossouw JE, Carr JJ, Langer RD, Hsia J, et al. Estrogen therapy and coronary-artery calcification. N Engl J Med 2007;356:2591-602.

    Google Scholar 

  18. 18

    Vitale C, Mercuro G, Cerquetani E, Marazzi G, Patrizi R, Pellicia F et al. Time since menopause influences the acute and chronic effect of estrogens on endothelial function. Arterioscler Throm Vasc Biol 2008;28:348-52.

    Google Scholar 

  19. 19

    Freedman RR, Norton D, Woodward S, Cornelissen G. Core body temperature and circadian rythm of hot flashes in menopausal women. J Clin Endocrinol Metab 1995;80:2354-8.

    Google Scholar 

  20. 20

    Nelson HG. Menopause. Lancet 2008;371:760-70.

  21. 21

    Staropoli CA, Flaws JA, Bush TL, Moulton AW. Predictors of menopausal hot flashes. J Womens Health 1998;7:1149-55.

    Google Scholar 

  22. 22

    Gold EB, Sternfeld B, Kelsey JL, Brown C, Mouton C, Reame N, et al. Relation of demographic and lifestyle factors to symptoms in a multi-racial/ethnic population of women 40-55 years of age. Am J Epidemiol 2000;152:463-73.

    Google Scholar 

  23. 23

    Thurston RC, Sowers MR, Sutton-Tyrrell K, Everson-Rose SA, Lewis TT, Edmundowicz D, et al. Abdominal adiposity and hot flashes among midlife women. Menopause 2008;15:429-34.

    Google Scholar 

  24. 24

    Gerber LM, Sievert LL, Warren K, Pickering TG, Schwartz JE. Hot flashes are associated with increased ambulatory blood pressure. Menopause 2007;14:308-15.

    Google Scholar 

  25. 25

    James GD, Sievert LL, Flanagan E. Ambulatory blood pressure and heart rate in relation to hot flash experience among women of menopausal age. Ann Human Biol 2004;31:49-58.

    Google Scholar 

  26. 26

    Ikeda H, Inoue T, Uemura S, Kaibara R, Tanaka H, Node K. Effects of candesartan for middle-aged and elderly women with hypertension and menopausal-like symptoms. Hypertens Res 2006;29:1007-12.

    Google Scholar 

  27. 27

    Freedman RR. Biochemical, metabolic and vascular mechanisms in menopausal hot flashes. Fertil Steril 1998;70:332-7.

    Google Scholar 

  28. 28

    Wenger NK. Coronary heart disease: an older women’s major health risk. BMJ 1997; 5:1085-90.

    Google Scholar 

  29. 29

    Burt VL, Whelton P, Roccella EJ, Brown C, Cutler JA, Higgins M, et al. Prevalence of hypertension in the US adult population. Results from the Third National Health and Nutrition Examination Survey, 1988-1991. Hypertension 1995;25:305-13.

    Google Scholar 

  30. 30

    Wassertheil-Smoller S, Anderson G, Psaty BM, Black HR, Manson JE, Wong N, et al. Hypertension and its treatment in postmenopausal women. Baseline data from the Women’s Health Initiative. Hypertension 2000;36:780-9.

    Google Scholar 

  31. 31

    Fletcher AE, Bulpitt CJ, Tuomilehto J et al., on behalf of the Syst-Eur Trial investigators. Quality of life in elderly patients with isolated systolic hypertension: baseline data from the Syst-Eur Trial. J Hypertens 1998;16:1117-24.

    Google Scholar 

  32. 32

    Bellamy L, Casas JP, Hingorani AD, Williams DJ. Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis. BMJ 2007;335:974-85.

    Google Scholar 

  33. 33

    Conen D, Ridker PM, Buring JE, Glynn RJ. Risk of cardiovascular events among women with high normal blood pressure or blood pressure progression: prospective cohort study. BMJ 2007;335:432-40.

    Google Scholar 

  34. 34

    Conen D, Ridker PM, Mora S, Buring JE, Glynn RJ. Blood pressure and risk of developing type 2 diabetes mellitus: The Women’s Health Study. Eur Heart J 2007;28:2937-43.

    Google Scholar 

  35. 35

    Gierach GL, Johnson BD, Bairey Merz CN, Kelsey SF, Bittner V, Olson MB, et al. Hypertension, Menopause, and coronary artery disease risk in the Women’s Ischemia Syndrome Evaluation (WISE) Study. J Am Coll Cardiol 2006;47:50S-58S.

    Google Scholar 

  36. 36

    Oparil S. Women and hypertension. What did we learn from the Women’s Health Initiative? Cardiol Rev 2006;14:267-75.

    Google Scholar 

  37. 37

    Staessen JA, van der Heijden-Spek JJ, Safar ME, Den Hond E, Gasowski J, Fagard RH, et al. Menopause and the characteristics of the large arteries in a population study. J Hum Hypertens 2001;15:511-8.

    Google Scholar 

  38. 38

    Coylewright M, Reckelhoff JF, Ouyang P. Menopause and hypertension. An age-old debate. Hypertension 2008;51:952-9.

    Google Scholar 

  39. 39

    Khalil RA. Sex hormones as potential modulators of vascular function in hypertension. Hypertension 2005;46:249-54.

    Google Scholar 

  40. 40

    Reckelhoff JF. Gender differences in the regulation of blood pressure. Hypertension 2001;37:1199-208.

    Google Scholar 

  41. 41

    Ashraf MS, Vongpatanasin W. Estrogen and hypertension. Curr Hypertens Reports 2006;8:368-76.

    Google Scholar 

  42. 42

    Reckelhoff JF, Fortepiani LA. Novel mechanisms responsible for postmenopausal hypertension. Hypertension 2004;43:918-23.

    Google Scholar 

  43. 43

    Schunkert H, Danser AH, Hense H-W, Derkx FH, Kurzinger S, Riegger GA. Effects of estrogen replacement therapy on the reninangiotensin system in postmenopausal women. Circulation 1997;95:39-45.

    Google Scholar 

  44. 44

    Pechère-Bertschi A, Burnier M. Female sex hormones, salt, and blood pressure regulation. Am J Hypertens 2004;17:994-1001.

    Google Scholar 

  45. 45

    Narkiewicz K, Philips BG, Kato M, Hering D, Bieniaszewski L, Somers VK. Gender-selective interaction between aging, blood pressure and sympathetic nerve activity. Hypertension 2005;45: 522-5.

    Google Scholar 

  46. 46

    Rappelli A. Hypertension and obesity after the menopause. J Hypertens 2002;20:S26-S28.

    Google Scholar 

  47. 47

    Carr MC. The emerge of the metabolic syndrome with menopause. J Clin Endocrinol Metab 2003;88:2404-11.

    Google Scholar 

  48. 48

    Lloyd-Jones DM, Leip EP, Larson MG, D’Agostino RB, Beiser A, Wilson PWF, et al.Prediction of lifetime risk for cardiovascular disease by risk factor burden at 50 years of age. Circulation 2006;113:791-8.

    Google Scholar 

  49. 49

    Mosca L, Banka CL, Benjamin EJ, Berra K, Bushnell C, Dolor RJ, et al. Evidence- based guidelines for cardiovascular disease prevention in women: 2007 update. J Am Coll Cardiol 2007;49:1230-50.

    Google Scholar 

  50. 50

    Guidelines Committee. European guidelines on cardiovascular disease prevention in clinical practice: executive summary. Eur Heart J 2007;28:2375-414.

    Google Scholar 

  51. 51

    Conroy RM, Pyörälä K, Fitzgerald AP, Sans S, Menotti A, De Backer G, et al. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE-project. Eur Heart J 2003;24:987-1003.

    Google Scholar 

  52. 52

    Grady D. Management of menopausal symptoms. N Engl J Med 2006;355:2338-47.

    Google Scholar 

  53. 53

    Board of trustees of the North American Menopause Society (NAMS). Estrogen and progestogen use in postmenopausal women: July 2008 position statement of the North American Menopause Society. Menopause 2008;15:584-603.

    Google Scholar 

  54. 54

    Roberts H. Managing the Menopause. BMJ 2007;334:736-41.

  55. 55

    White WB, Hanes V, Chauhan V, Pitt B. Effects of a new hormone therapy, drospirenone and 17ß-oestradiol in postmenopausal women with hypertension. Hypertension 2006;48:246-53.

    Google Scholar 

  56. 56

    Preston RA, Norris PM, Alonso AB, Ni P, Hanes V, Larara AH. Randomized, placebo-controlled trial of the effects of drospirenone-estradiol on blood pressure and potassium balance in hypertensive postmenopausal women receiving hydrochlorothiazide. Menopause 2007;14:408-14.

    Google Scholar 

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Corresponding author

Correspondence to A. H. E. M. Maas.

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Department of Cardiology, Isala Clinics, Zwolle, the Netherlands

Department of Gynaecology, Medisch Spectrum Twente, Enschede, the Netherlands

A.H.E.M. Maas Department of Cardiology, Isala Clinics, PO Box 10500, 8000 GM Zwolle, the Netherlands

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Maas, A.H.E.M., Franke, H.R. Women’s health in menopause with a focus on hypertension. NHJL 17, 68–72 (2009).

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  • cardiovascular risk
  • hormones
  • hypertension
  • menopause
  • prevention