People often think of hypertension as a condition that primarily affects males, but this assumption is false. According to the American Heart Association, females account for almost 52% of deaths resulting from hypertension. People’s blood pressure often increases as they age. As people age, they are also more likely to experience menopause. However, there are definite links between increases in blood pressure and the changes a person’s body undergoes when they experience menopause.

A person may experience blood pressure changes throughout the different stages of menopause, including during perimenopause and menopause and after menopause.

Perimenopause

Perimenopause is where a person’s body begins making the transition to menopause. The prevalence of hypertension is higher in postmenopausal people than in premenopausal people. However, a 2015 study noted that there is very little research into what happens to a person’s blood pressure when they are in the perimenopausal phase. The 2015 study found that the prevalence of hypertension was significantly different between early and late menopausal transition. The prevalence of hypertension increased the further a woman was into her perimenopause.

Premature menopause

A 2020 study outlines a potential link between premature menopause and increased blood pressure. Premature menopause is menopause that occurs before the age of 40. This study suggests that people who have experienced premature menopause should have additional screening to monitor their blood pressure.

Postmenopause

According to Blood Pressure UK, a person’s risk of having a heart attack is five times higher after menopause than before. This is likely due to increased blood pressure.

People who are going through menopause experience a significant drop in the hormone estrogen. This hormone has a beneficial effect on blood pressure. Firstly, estrogen has a vasodilative effect, meaning it helps promote blood flow by keeping the blood vessels open. Secondly, estrogen helps keep cholesterol levels low, and this helps prevent the narrowing and hardening of the arteries due to cholesterol deposits or plaques. As such, a person experiencing decreased estrogen levels as a result of menopause may be at increased risk of developing hypertension. People who are going through menopause may also experience weight gain. Being 20 pounds or more overweight can increase the risk of high blood pressure, so menopause can inadvertently contribute to this risk. According to a 2014 review, some studies have shown that people who have experienced menopause are more sensitive to salt than those who have yet to go through menopause. Sensitivity to salt can mean that there is excess salt in the bloodstream. Excess salt increases fluid retention, and this increases blood pressure.

There is nothing that a person can do to prevent high blood pressure completely. However, they can take steps to minimize their risk of developing high blood pressure. Lifestyle changes that people can try to help reduce high blood pressure include:

• quitting smoking
• reducing alcohol intake
• reducing caffeine intake
• limiting salt intake to less than 2.3 grams per day
• eating healthily
• exercising regularly
• maintaining a healthy weight

Doctors can recommend a variety of medications to control high blood pressure. The treatment a person receives will depend on their individual needs. Some examples include:

• Angiotensin-converting enzyme inhibitors: These inhibit a chemical that causes the narrowing of the arteries called angiotensin. This helps the blood vessels open up and relax. This medication can also increase sodium excretion.
• Angiotensin II receptor blockers: These block the angiotensin receptors, helping the blood vessels to dilate. According to a 2014 study, ARBs can also increase sodium excretion.
• Vasodilators: These relax the muscles in the blood vessel walls, allowing blood to flow through more easily.
• Alpha-2 receptor agonists: These decrease activity in the sympathetic nervous system, which leads to a drop in blood pressure and heart rate.
• Alpha-blockers: These prevent the hormone norepinephrine from tightening the walls of blood vessels, which allows the vessels to remain dilated. This helps promote blood flow and reduce blood pressure.
• Beta-blockers: These block the action of the hormone epinephrine. This results in the heart beating more slowly and less forcefully, which leads to a reduction in blood pressure.
• Combined alpha- and beta-blockers: These intravenous medications are for people who are experiencing a hypertensive crisis. This is the medical term for a severe increase in blood pressure that could lead to a stroke.
• Calcium channel blockers: These prevent calcium from entering cells within the heart and arteries. Since calcium causes the heart and arteries to contract more strongly, blocking calcium lowers blood pressure.
• Central agonists: These block brain signals that increase heart rate and constrict blood vessels.
• Peripheral adrenergic inhibitors: These block neurotransmitters in the brain that ordinarily encourage blood vessels to constrict.
• Diuretics: These help reduce water retention in the body, which has the effect of lowering blood pressure.

There are many steps a person can take to manage their blood pressure and lower their risk of developing complications from high blood pressure. Examples include:

• Implementing lifestyle changes: People who are at increased risk of developing high blood pressure may benefit from making some of the lifestyle changes outlined above.
• Taking regular blood pressure readings: Hypertension typically does not cause any symptoms, so the only way for a person to know if they have it is by measuring their blood pressure regularly. A person can speak with their doctor about getting a blood pressure check, or they can purchase their own blood pressure monitor and check their blood pressure at home. The latter option may be more convenient for people who have a diagnosis of hypertension and those who are at increased risk of developing the condition.
• Discussing a treatment plan with a doctor: People can speak with a healthcare professional to put together an action plan to help manage, or even reduce, their high blood pressure.
• Taking medications according to the doctor’s instructions: It is essential that people with hypertension take any and all medications their doctor prescribes, even if they feel well. Hypertension typically does not cause any symptoms, so a person may feel completely well until a complication of high blood pressure occurs, such as a stroke.

People, especially older adults, should have regular checkups with a doctor. These checkups can screen for a wide number of health conditions, including high blood pressure. People who are going through perimenopause or menopause may experience symptoms related to their changing hormone levels. Anyone who experiences unpleasant or uncomfortable symptoms should contact a doctor, who may be able to offer medications to alleviate symptoms and prevent possible complications. A person should also contact a doctor if they experience heart palpitations. Although these are a symptom of menopause, they can also be an indication of thyroid disease in those undergoing menopause.

People who have experienced menopause are at increased risk of high blood pressure compared to those who have yet to go through menopause. This increase in risk is primarily due to hormonal and bodily changes that occur during and after menopause. There is nothing a person can do to eliminate their risk of developing hypertension. However, people can make lifestyle changes to maintain healthy blood pressure. These include exercising regularly, following a healthy diet, and reducing their intake of salt, caffeine, and alcohol. Hypertension typically does not cause any symptoms, so the only way a person will know they have it is through regularly monitoring their blood pressure. A person who is at risk of developing high blood pressure due to menopause can speak with their doctor about regular blood pressure monitoring. People who already have a diagnosis of high blood pressure should take any medications their doctor prescribes in order to prevent complications, such as stroke.